slicksurfer
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TITLE OF PROCEDURE:
Aortogram, left subclavian chronic total occlusion attempted angioplasty, left vertebral angioplasty and stent.
BRIEF HISTORY: This is a 73-year-old male with left subclavian steal syndrome and left arm weakness. The patient has also had a left vertebral stenosis of 80 percent, referred for angioplasty and stent of both territories. The patient was explained in detail the risks, benefits, and alternatives to the procedure, and he agreed to proceed. A witnessed consent was signed and placed on the chart.
DESCRIPTION OF PROCEDURE: The patient was brought to the endovascular suite. He was prepped and draped in the usual sterile fashion. One percent lidocaine was used to anesthetize the right groin. There, a 6 French femoral arterial sheath was placed via Seldinger technique, and a pigtail catheter showed the occlusion of the left subclavian with heavy calcification. The vertebral artery also had an 80 percent diameter stenosis. The sheath was exchanged for an 8 French sheath. Heparin was given to maintain the ACT greater than 250, and a 0.035 angled and straight glide wires with a support catheter were used to try to cross the occlusion. This did not cross due to significant cap rigidity. This was followed by the use of a Frontrunner catheter and once again did not cross. Ultimately, it was felt that there was too heavy a calcification, despite multiple attempts with the angled and straight glidewires, and ultimately the vertebral artery was then engaged using a 0.014 BMW wire, and direct stenting was performed with a 3.5 x 15 millimeter Promus drug-eluting stent, deployed at 10 atmospheres for 30 seconds, leaving a 0 percent residual stenosis.
IMPRESSION:
1. Status post successful left ostial vertebral angioplasty and stent, 80 percent prelesion stenosis, 0 percent post restenosis, treated with a 3.5 x 15 Promus.
2. 100 percent left subclavian artery stenosis, unable to be crossed with the angled and straight glidewires and a Frontrunner. We will try a left arm brachial approach in the future.
3. No complications.
- We coded 75625 for the aortagram and 0075T for the stent placement.
- Did we code this right?
Aortogram, left subclavian chronic total occlusion attempted angioplasty, left vertebral angioplasty and stent.
BRIEF HISTORY: This is a 73-year-old male with left subclavian steal syndrome and left arm weakness. The patient has also had a left vertebral stenosis of 80 percent, referred for angioplasty and stent of both territories. The patient was explained in detail the risks, benefits, and alternatives to the procedure, and he agreed to proceed. A witnessed consent was signed and placed on the chart.
DESCRIPTION OF PROCEDURE: The patient was brought to the endovascular suite. He was prepped and draped in the usual sterile fashion. One percent lidocaine was used to anesthetize the right groin. There, a 6 French femoral arterial sheath was placed via Seldinger technique, and a pigtail catheter showed the occlusion of the left subclavian with heavy calcification. The vertebral artery also had an 80 percent diameter stenosis. The sheath was exchanged for an 8 French sheath. Heparin was given to maintain the ACT greater than 250, and a 0.035 angled and straight glide wires with a support catheter were used to try to cross the occlusion. This did not cross due to significant cap rigidity. This was followed by the use of a Frontrunner catheter and once again did not cross. Ultimately, it was felt that there was too heavy a calcification, despite multiple attempts with the angled and straight glidewires, and ultimately the vertebral artery was then engaged using a 0.014 BMW wire, and direct stenting was performed with a 3.5 x 15 millimeter Promus drug-eluting stent, deployed at 10 atmospheres for 30 seconds, leaving a 0 percent residual stenosis.
IMPRESSION:
1. Status post successful left ostial vertebral angioplasty and stent, 80 percent prelesion stenosis, 0 percent post restenosis, treated with a 3.5 x 15 Promus.
2. 100 percent left subclavian artery stenosis, unable to be crossed with the angled and straight glidewires and a Frontrunner. We will try a left arm brachial approach in the future.
3. No complications.
- We coded 75625 for the aortagram and 0075T for the stent placement.
- Did we code this right?
