Wiki Help me understand lower extremity procedures

[espressoguy]

I am taking the CCC next month and the more I study the more confused I get with these procedures. How would this be coded:

OPERATIVE NOTE: The patient was brought to the cardiac catheterization lab,
draped and prepped in usual sterile fashion. The left common femoral artery
was accessed using micropuncture technique and a 5-French sheath was
placed. We then took a rim catheter and performed abdominal aortogram:
Abdominal aortogram demonstrated bilateral renal arteries that were patent.
The distal aorta has mild disease. The bilateral common iliac arteries have
trivial disease. The external iliac arteries have no disease. The internal
iliac artery on the right is patent and the left was difficult to
appreciate. The IMA is patent.

I then took the rim catheter and gained access into the contralateral
common femoral artery and took AQUA TEMPO catheter and performed lower
extremity angiography from the level of the right common femoral artery.
Angiography here demonstrated: Profunda that was patent and common femoral
with no disease. There is 100% occlusion of the superficial femoral artery
with a small nub. The SFA reconstitutes about 220 mm distal to the proximal
occlusion. The popliteal has trivial disease on the right. There is a
2-vessel runoff with AT patent and the peroneal patent. It appears that the
posterior tibial on the right is occluded. There does appear to be some
collaterals to the PT. We then did the following:

1. Switched over to a 7-French destination sheath and placed it into the
common femoral artery.
2. Using a mini support catheter and a glide wire, I was able to traverse
through the 100% occlusion. We did reconstitute intraluminally at the
distal aspect of it.
3. Pre-dilatation of the entire lesion with a 3 x 210 mm balloon.
4. Before, we did the percutaneous transluminal angioplasty, we did put a
5.0 Spyder. We then did a Hawkwone with 2 runs lateral and medial.
5. Placement of a 5.0 x 120 drug-coated balloon x 2.
6. Placement of a 6 x 200 mm EverFlex self-expanding stent with overlap
with a 6 x 60 EverFlex self-expanding stent.
7. Post dilatation with a 6 x 200 percutaneous transluminal angioplasty
EverCross. It was excellent result. Unfortunately, we did have to stent
because there was some small dissection planes noted in the proximal and
the distal aspect of the 100% occlusion. There was 2-vessel runoff at the
end of the case.

We then moved the sheath back into the external iliac artery on the left. I
performed segmental angiography. This demonstrated the following: The left
common femoral artery had no disease. The distal SFA has about a 40% lesion
on the left. The popliteal has trivial disease. The AT is heavily diseased
and potentially 100% occluded on the left. The TP trunk has no disease. The
peroneal has no disease. There does appear to be 100% occlusion of the
posterior tibial on the right.

IMPRESSION AND RECOMMENDATIONS: Successful atherectomy/percutaneous
transluminal angioplasty/stenting of right superficial femoral artery
without any complications. The patient should continue Plavix for 2-3
months. She will follow up with me in clinic in a month.

The person who codes for the hospital entered this as 75716, 37227. When I asked him why he didn't include the 75625 he said it was because it wasn't a complete study. If that's the case what more needs to be reviewed? Also what about the catheter placement? 36246?

Thanks in advance.

 

[Jim Pawloski]

I am taking the CCC next month and the more I study the more confused I get with these procedures. How would this be coded:



The person who codes for the hospital entered this as 75716, 37227. When I asked him why he didn't include the 75625 he said it was because it wasn't a complete study. If that's the case what more needs to be reviewed? Also what about the catheter placement? 36246?

Thanks in advance.

I would bill for the abdominal aorta since the renal arteries and the IMA are described. I wondering if the coder wants all of the visceral arteries described?
Thanks,
Jim Pawloski, CIRCC

 

[theresa.dix@tennova.com]

espressoguy,

The best way to understand the codes is take a look at the cpt code descriptions for 75630,75625 and 75716,

75630 is aortography,abdominal plus ilio/femoral extremity
75625 is aortography abdominal
75716 is angiography extremity bilateral

which codes you use depends on where the shot was and what was interpreted.

the reason why 75625 and 75716 was not used is because to use both of these codes requires two cath placements. One in the aorta(75625) and one repositioned above the bifurcation(75716). Without clear documentation of two cath placements you would not use both of these codes. When this is done it is called a basic study.

For this case I would use 75630 and 37227. The reason for this is 75630 is for interpretation of the entire aorta plus extremity at least to the common femoral. See above description of the code. We know he shot up high in the aorta because he mentions the renals and he also mentions the external iliacs.

If he wouldnt have mentioned the renals and just the aorta then 75625. See description above.

If he would have just mentioned the iliacs then 75716. See description above.

You would not code the cath placement because it is bundled into the intervention code 37227.

Hope this isnt to confusing.

 

[espressoguy]

Thank you Jim and Theresa.

Let me chew on this for awhile. I'm still a little confused, but the fog is slowly lifting. My employer has ordered a copy of Dr. Z's reference book and I'm hoping it will arrive soon. I'm sure this will help clear up any remaining confusion.

One thing, Theresa. Isn't this justification for 75716 and 75625 instead of 75630?

I then took the rim catheter and gained access into the contralateral
common femoral artery and took AQUA TEMPO catheter and performed lower
extremity angiography from the level of the right common femoral artery.
Angiography here demonstrated. . .

And then:

We then moved the sheath back into the external iliac artery on the left. I performed segmental angiography. This demonstrated the following. . .