I need some help, I think I have the codes down, not too sure as IR is not great for me, this is the report:
PROTOCOL: A 6-French sheath was placed in the right femoral artery.
A Contra catheter was then taken to the descending aorta and
abdominal aortic angiography was done. The iliacs were free of
disease. The Contra catheter was then placed from the right iliac
artery to the left superficial femoral artery using a glide wire.
Angiography demonstrated that the iliacs and the SFAs were clean.
Popliteal artery was normal. Below the knee, the patient had a 1
vessel runoff through the peroneal artery. The anterior tibial
artery occluded proximally and the posterior tibial artery had
multiple collaterals and was occluded in the mid vessel. The
peroneal artery was occluded above the ankle and then gave
collaterals to the anterior tibial artery and the posterior tibial
artery. There was a posterior tibial artery at the ankle. We
attempted to angioplasty this posterior tibial artery.
The Contra catheter was removed over a long Magic Torque wire. A
90-cm destination sheath was placed in the right popliteal artery. A
PT 2 wire was placed in the Quick-Cross catheter and then placed down
the posterior tibial artery; however, there were multiple collaterals
in the posterior tibial artery and we could not move. I was not sure
which was true posterior tibial artery and which was a collateral.
Then we attempted to enter the posterior tibial artery from a
retrograde fashion.
The left foot was prepped and draped sterilely. Lidocaine was
introduced in the posterior tibial artery and we spent a great amou
of time to enter the posterior tibial artery. However, this was no
successful. We used a day ultrasound probe and used a SmartNeedle
and then fluoroscopy and injections through the leg as well. We
could enter the vessel, however, the wire would go onto the
collateral and could not stay in the true lumen of the major vessel
After about 1.5 hours of attempting to enter the posterior tibial
artery, further attempts were aborted. The sheath was removed and
and a Mynx was used. The patient was given Angio-Seal during the
procedure; however, this was stopped at the end of the procedure.
FINDINGS:
1. The bilateral iliacs and superficial femoral arteries are free of
disease.
2. The left popliteal artery is free of disease.
3. There is 1-vessel runoff through the peroneal artery. The
posterior tibial artery and anterior tibial arteries are occluded and
filled by collaterals. Unfortunately, we could not angioplasty the
posterior tibial artery as there were too many collaterals to know
exactly which one was the true lumen from above, and we could not
enter it from retrograde approach. The patient will be continued on
medical therapy.
The codes I come up with for CPT are:
37228-52
75625
93005-59 (EKG showed heart block, done prior to surgery)
Any ideas would be greatly appreciated!
Mary G
PROTOCOL: A 6-French sheath was placed in the right femoral artery.
A Contra catheter was then taken to the descending aorta and
abdominal aortic angiography was done. The iliacs were free of
disease. The Contra catheter was then placed from the right iliac
artery to the left superficial femoral artery using a glide wire.
Angiography demonstrated that the iliacs and the SFAs were clean.
Popliteal artery was normal. Below the knee, the patient had a 1
vessel runoff through the peroneal artery. The anterior tibial
artery occluded proximally and the posterior tibial artery had
multiple collaterals and was occluded in the mid vessel. The
peroneal artery was occluded above the ankle and then gave
collaterals to the anterior tibial artery and the posterior tibial
artery. There was a posterior tibial artery at the ankle. We
attempted to angioplasty this posterior tibial artery.
The Contra catheter was removed over a long Magic Torque wire. A
90-cm destination sheath was placed in the right popliteal artery. A
PT 2 wire was placed in the Quick-Cross catheter and then placed down
the posterior tibial artery; however, there were multiple collaterals
in the posterior tibial artery and we could not move. I was not sure
which was true posterior tibial artery and which was a collateral.
Then we attempted to enter the posterior tibial artery from a
retrograde fashion.
The left foot was prepped and draped sterilely. Lidocaine was
introduced in the posterior tibial artery and we spent a great amou
of time to enter the posterior tibial artery. However, this was no
successful. We used a day ultrasound probe and used a SmartNeedle
and then fluoroscopy and injections through the leg as well. We
could enter the vessel, however, the wire would go onto the
collateral and could not stay in the true lumen of the major vessel
After about 1.5 hours of attempting to enter the posterior tibial
artery, further attempts were aborted. The sheath was removed and
and a Mynx was used. The patient was given Angio-Seal during the
procedure; however, this was stopped at the end of the procedure.
FINDINGS:
1. The bilateral iliacs and superficial femoral arteries are free of
disease.
2. The left popliteal artery is free of disease.
3. There is 1-vessel runoff through the peroneal artery. The
posterior tibial artery and anterior tibial arteries are occluded and
filled by collaterals. Unfortunately, we could not angioplasty the
posterior tibial artery as there were too many collaterals to know
exactly which one was the true lumen from above, and we could not
enter it from retrograde approach. The patient will be continued on
medical therapy.
The codes I come up with for CPT are:
37228-52
75625
93005-59 (EKG showed heart block, done prior to surgery)
Any ideas would be greatly appreciated!
Mary G
