mbprzychocki
Contributor
Can I get some help on coding this? This is my first subclavian intervention and I have read some of the older posts and various articles, but the charges are abnormally stout for what we normally bill for and I want to make sure I am correct in my coding.....
From what I have read this should be what is billed -
36215-26
75710-26
35475-26
75962-26
37205-26,59
75960-26
This is an 80-year-old Caucasian male with known severe obstructive disease in the left subclavian. This had been associated with numbness and weakness in the left arm. At this point in time no TIA type symptomatology, no subclavian steal, although he is sedentary, and no angina. The patient was referred for subclavian intervention. This is a rather large subclavian with a very large eccentric bulky lesion with some calcification. After the risks had been discussed with the patient and the patient's family, he was brought into the catheterization laboratory where the left groin was prepped and draped in the standard fashion and local anesthesia was accomplished with the subcutaneous infiltration of 1% Xylocaine without epinephrine. The patient is morbidly obese, that certainly created an increased risk factor as well at the groin. The 6 French sheath was placed. A 6 French pigtail catheter was advanced to the arch of the aorta and an aortogram was done demonstrating that the lesion did not appear to go all the way to the ostium. I then used a Judkins 6 French #4 right coronary artery catheter for selective angiography, in several views. Following this, I used and exchange angled glidewire and attempted to advance a cast 10 x 38 mm bare metal stent, this would not pass. I took my coronary catheter back up over wire and exchanged with wire for a Wholey wire and then went up with a 6 x 40 balloon, did preliminary dilation and now I was able to advance the stent. It was positioned. It was deployed at 10 atmospheres. Final injection of contrast demonstrated at most 10% residual narrowing, but it was felt that with this being a calcified lesion and eccentric, there was higher risk for vessel rupture if we tried to go for full expansion. The patient did received 7000 units of heparin for the procedure, and his final ACT was 172 seconds. At the end of the procedure he was given 600 mg of Plavix and 81 mg of aspirin chewed x3 (he had received 81 mg chewed at home). At the end of the case, the sidearm of the sheath was aspirated and flushed. 50% contrast was injected. During the case we had had to expand the size of the sheath out to an 8 French and there was some spasm that occurred in the femoral artery that was effectively relieved with 400 mcg of nitroglycerin through the sidearm of the sheath. The left external iliac was fine. The common femoral had mild disease, as did the profunda and superficial femoral arteries proximally, and the bifurcation was fine. The insertion site was well above the bifurcation. An 8 French Angio-Seal device was used with good hemostasis. The patient was transported back to his room.
FINAL IMPRESSIONS
1. Symptomatic eccentric tight obstruction in the left subclavian.
2. Successful intervention using a combination of balloon angioplasty followed by stenting.
Thank you.
From what I have read this should be what is billed -
36215-26
75710-26
35475-26
75962-26
37205-26,59
75960-26
This is an 80-year-old Caucasian male with known severe obstructive disease in the left subclavian. This had been associated with numbness and weakness in the left arm. At this point in time no TIA type symptomatology, no subclavian steal, although he is sedentary, and no angina. The patient was referred for subclavian intervention. This is a rather large subclavian with a very large eccentric bulky lesion with some calcification. After the risks had been discussed with the patient and the patient's family, he was brought into the catheterization laboratory where the left groin was prepped and draped in the standard fashion and local anesthesia was accomplished with the subcutaneous infiltration of 1% Xylocaine without epinephrine. The patient is morbidly obese, that certainly created an increased risk factor as well at the groin. The 6 French sheath was placed. A 6 French pigtail catheter was advanced to the arch of the aorta and an aortogram was done demonstrating that the lesion did not appear to go all the way to the ostium. I then used a Judkins 6 French #4 right coronary artery catheter for selective angiography, in several views. Following this, I used and exchange angled glidewire and attempted to advance a cast 10 x 38 mm bare metal stent, this would not pass. I took my coronary catheter back up over wire and exchanged with wire for a Wholey wire and then went up with a 6 x 40 balloon, did preliminary dilation and now I was able to advance the stent. It was positioned. It was deployed at 10 atmospheres. Final injection of contrast demonstrated at most 10% residual narrowing, but it was felt that with this being a calcified lesion and eccentric, there was higher risk for vessel rupture if we tried to go for full expansion. The patient did received 7000 units of heparin for the procedure, and his final ACT was 172 seconds. At the end of the procedure he was given 600 mg of Plavix and 81 mg of aspirin chewed x3 (he had received 81 mg chewed at home). At the end of the case, the sidearm of the sheath was aspirated and flushed. 50% contrast was injected. During the case we had had to expand the size of the sheath out to an 8 French and there was some spasm that occurred in the femoral artery that was effectively relieved with 400 mcg of nitroglycerin through the sidearm of the sheath. The left external iliac was fine. The common femoral had mild disease, as did the profunda and superficial femoral arteries proximally, and the bifurcation was fine. The insertion site was well above the bifurcation. An 8 French Angio-Seal device was used with good hemostasis. The patient was transported back to his room.
FINAL IMPRESSIONS
1. Symptomatic eccentric tight obstruction in the left subclavian.
2. Successful intervention using a combination of balloon angioplasty followed by stenting.
Thank you.
It makes me feel better that I am not too far off.