imoore65
Contributor
Good Afternoon,
Is the following report all bundled into 37218 or can we code for each selective cath placement/Radiology S+I in addition to stent/angioplasty?
Procedure steps:
? Percutaneous access right common femoral artery
? Arch aortogram
? Selective brachiocephalic arteriogram
? Sub-selective common carotid arteriogram
? Sub-selective right subclavian arteriogram
? Percutaneous transluminal angioplasty with stenting of the right common carotid artery
? Post stenting angioplasty.
? Follow-up arteriogram.
Description: Using Seldinger technique, the right common femoral artery is percutaneously accessed followed by placement of a 5-French sheath. Over a guidewire, a 5-French pigtail catheter is passed into the aortic arch followed by power injection of contrast for digital arteriogram. Catheter was then exchanged for a 5-French KMP catheter, which was used to select the origin of the brachiocephalic artery. The catheter was advanced into the brachiocephalic artery followed by power injection of contrast for a digital brachiocephalic arteriogram. The catheter is then further sub-selectively placed in the proximal right subclavian artery followed by hand injection of contrast for a digital arteriogram. The images were than evaluated.
An arterio-venous fistula was seen arising off the base of the right common carotid artery extending over to the right internal jugular vein. The catheter was sub-selectively placed in the origin of this fistula to demonstrate this fistulous connection with hand injection of contrast. The catheter was then re-directed into the right common carotid artery. A 0.035 inch guidewire was passed distally. Over this, the catheter and sheath were exchanged for a 6-French sheath. Coaxially, a 6 x 22 mm atrium covered stent was passed and positioned across the base of the right common carotid artery. This was subsequently deployed with balloon angioplasty. Repeat balloon angioplasty was then performed using an 8 mm balloon to expand the stent tighter against the Bessel wall. The balloon catheter was then removed. The sheath was then exchanged for a long 90 cm Brite Tip sheath was positioned at the level of the brachiocephalic artery. Injection of contrast was then carried out showing unsuccessful occlusion of the arteriovenous fistula.
It was decided that the patient would be operatively treated at that point. The sheath was then removed and exchanged for a short 6-French sheath. This was sutured in place to the skin and a sterile dressing was applied.
Thanks for all of your help,
Ingrid Moore, CPC, RCC
Is the following report all bundled into 37218 or can we code for each selective cath placement/Radiology S+I in addition to stent/angioplasty?
Procedure steps:
? Percutaneous access right common femoral artery
? Arch aortogram
? Selective brachiocephalic arteriogram
? Sub-selective common carotid arteriogram
? Sub-selective right subclavian arteriogram
? Percutaneous transluminal angioplasty with stenting of the right common carotid artery
? Post stenting angioplasty.
? Follow-up arteriogram.
Description: Using Seldinger technique, the right common femoral artery is percutaneously accessed followed by placement of a 5-French sheath. Over a guidewire, a 5-French pigtail catheter is passed into the aortic arch followed by power injection of contrast for digital arteriogram. Catheter was then exchanged for a 5-French KMP catheter, which was used to select the origin of the brachiocephalic artery. The catheter was advanced into the brachiocephalic artery followed by power injection of contrast for a digital brachiocephalic arteriogram. The catheter is then further sub-selectively placed in the proximal right subclavian artery followed by hand injection of contrast for a digital arteriogram. The images were than evaluated.
An arterio-venous fistula was seen arising off the base of the right common carotid artery extending over to the right internal jugular vein. The catheter was sub-selectively placed in the origin of this fistula to demonstrate this fistulous connection with hand injection of contrast. The catheter was then re-directed into the right common carotid artery. A 0.035 inch guidewire was passed distally. Over this, the catheter and sheath were exchanged for a 6-French sheath. Coaxially, a 6 x 22 mm atrium covered stent was passed and positioned across the base of the right common carotid artery. This was subsequently deployed with balloon angioplasty. Repeat balloon angioplasty was then performed using an 8 mm balloon to expand the stent tighter against the Bessel wall. The balloon catheter was then removed. The sheath was then exchanged for a long 90 cm Brite Tip sheath was positioned at the level of the brachiocephalic artery. Injection of contrast was then carried out showing unsuccessful occlusion of the arteriovenous fistula.
It was decided that the patient would be operatively treated at that point. The sheath was then removed and exchanged for a short 6-French sheath. This was sutured in place to the skin and a sterile dressing was applied.
Thanks for all of your help,
Ingrid Moore, CPC, RCC