cdc1cori
New
Can someone please help me with coding the following report? I am so lost with these new codes for 2011. 
Thanks in advance!
RESULT: Procedures performed:
1. Left lower extremity angiogram.
2. Left superficial femoral artery/profundofemoral artery
angioplasty.
3. Left superficial femoral artery chemical and mechanical
thrombolyzes and stent placement.
4. Left popliteal/peroneal artery mechanical thrombolysis.
History: 46-year-old female with recurrent left lower extremity
arterial insufficiency ischemic symptoms. Patient has known
peripheral arterial disease and is status post prior left lower
extremity arteriogram and stent graft placement and angioplasty
on
Technique: Following a detailed discussion with the patient
regarding the procedure, risks, benefits, and alternatives,
informed consent was obtained and placed in the patient's
medical record. This procedure is performed with conscious
sedation using IV Versed and fentanyl. These were minister by
radiology nursing staff personnel. Please refer to their notes
for full details.
The patient was placed supine on the angiography table. The
right groin was prepped and draped in usual sterile fashion.
The right common femoral artery was visualized under
ultrasound an image was store for documentation of the access
site. The skin and subcutaneous tissues were anesthetized
lidocaine. A scalpel was used to make a small incision at the
puncture site. Under ultrasound guidance a myocardial was
placed into the right common femoral artery directed towards
the abdominal aorta. A microwire was advanced through the
needle was removed and exchanged for a 4 French micropuncture
dilator. The wire and inner dilator were removed and exchanged
for a Bentson wire to advance under fluoroscopic guidance into
the abdominal aorta. A 4 French sheath was placed.
A pigtail catheter was advanced into the abdominal aorta just
above the level of the celiac trunk and abdominal aortogram was performed.
The catheter was then pulled back to just above the aortoiliac
bifurcation and oblique aortoiliac arteriograms of the pelvis
were performed.
The catheter was then draped over the aortoiliac bifurcation
and an angled Glidewire was advanced into the left common
iliac, external iliac, common femoral arteries. The catheter
was removed and exchanged for an angled glide catheter. The
wire was removed and exchanged for an exchange length Amplatz
wire.
An angled glide catheter was advanced to the distal left common
femoral artery. A left lower extremity arteriogram was
performed.
A 6 French, 40 cm long Balkan sheath was exchanged for the 4
French sheath and advanced under fluoroscopic guidance into the
left common femoral artery.
An angled glide catheter and Glidewire were used to select
across the distal left common femoral artery/proximal
profundofemoral artery junction. The wire was exchanged for the
Amplatz wire. Angioplasty was performed with a 4 mm x40
millimeters angioplasty balloon. A followup arteriogram was
performed.
The wire was then pulled back into the left common femoral
artery. An angled lie catheter and angled Glidewire were used
to select the left superficial femoral artery across the
high-grade proximal stenosis. Angioplasty was then performed
using a 5 mm x 40 mm angioplasty balloon across the left common
femoral artery/superficial femoral artery stenosis. A followup
arteriogram was performed.
A total of 8000 units of heparin, 8 mg of TPA thrombolytic, and
AngioJet mechanical thrombolyzes were required in conjunction
with 5 mm x 120mm angioplasty to recanalize the newly
thrombosed right superficial femoral artery. A followup
arteriogram was performed.
Mechanical thrombolyzes was performed in the distal left
popliteal artery and into the tibioperoneal trunk. This was
followed by 4 mm balloon angioplasty.
The distal right lower extremity arteriogram with runoff was
performed.
Mechanical thrombolyzes was performed throughout the length of
the left superficial femoral artery an additional time. A left
common femoral artery/superficial femoral arteriogram was
performed.
Repeat angioplasty and mechanical thrombolyzes was required in
the left superficial femoral artery and popliteal artery.
A 5 mm x 30 mm Metronic stent was deployed across the most
proximal portion of the left superficial femoral artery.
A followup arteriogram was performed.
A completion infrapopliteal left lower extremity arteriogram
was performed.
Once the ACT level reached below 175, the sheath was removed
and hemostasis was obtained with manual compression. The
patient tolerated the procedure well and left the department in
baseline condition.
Thanks in advance!RESULT: Procedures performed:
1. Left lower extremity angiogram.
2. Left superficial femoral artery/profundofemoral artery
angioplasty.
3. Left superficial femoral artery chemical and mechanical
thrombolyzes and stent placement.
4. Left popliteal/peroneal artery mechanical thrombolysis.
History: 46-year-old female with recurrent left lower extremity
arterial insufficiency ischemic symptoms. Patient has known
peripheral arterial disease and is status post prior left lower
extremity arteriogram and stent graft placement and angioplasty
on
Technique: Following a detailed discussion with the patient
regarding the procedure, risks, benefits, and alternatives,
informed consent was obtained and placed in the patient's
medical record. This procedure is performed with conscious
sedation using IV Versed and fentanyl. These were minister by
radiology nursing staff personnel. Please refer to their notes
for full details.
The patient was placed supine on the angiography table. The
right groin was prepped and draped in usual sterile fashion.
The right common femoral artery was visualized under
ultrasound an image was store for documentation of the access
site. The skin and subcutaneous tissues were anesthetized
lidocaine. A scalpel was used to make a small incision at the
puncture site. Under ultrasound guidance a myocardial was
placed into the right common femoral artery directed towards
the abdominal aorta. A microwire was advanced through the
needle was removed and exchanged for a 4 French micropuncture
dilator. The wire and inner dilator were removed and exchanged
for a Bentson wire to advance under fluoroscopic guidance into
the abdominal aorta. A 4 French sheath was placed.
A pigtail catheter was advanced into the abdominal aorta just
above the level of the celiac trunk and abdominal aortogram was performed.
The catheter was then pulled back to just above the aortoiliac
bifurcation and oblique aortoiliac arteriograms of the pelvis
were performed.
The catheter was then draped over the aortoiliac bifurcation
and an angled Glidewire was advanced into the left common
iliac, external iliac, common femoral arteries. The catheter
was removed and exchanged for an angled glide catheter. The
wire was removed and exchanged for an exchange length Amplatz
wire.
An angled glide catheter was advanced to the distal left common
femoral artery. A left lower extremity arteriogram was
performed.
A 6 French, 40 cm long Balkan sheath was exchanged for the 4
French sheath and advanced under fluoroscopic guidance into the
left common femoral artery.
An angled glide catheter and Glidewire were used to select
across the distal left common femoral artery/proximal
profundofemoral artery junction. The wire was exchanged for the
Amplatz wire. Angioplasty was performed with a 4 mm x40
millimeters angioplasty balloon. A followup arteriogram was
performed.
The wire was then pulled back into the left common femoral
artery. An angled lie catheter and angled Glidewire were used
to select the left superficial femoral artery across the
high-grade proximal stenosis. Angioplasty was then performed
using a 5 mm x 40 mm angioplasty balloon across the left common
femoral artery/superficial femoral artery stenosis. A followup
arteriogram was performed.
A total of 8000 units of heparin, 8 mg of TPA thrombolytic, and
AngioJet mechanical thrombolyzes were required in conjunction
with 5 mm x 120mm angioplasty to recanalize the newly
thrombosed right superficial femoral artery. A followup
arteriogram was performed.
Mechanical thrombolyzes was performed in the distal left
popliteal artery and into the tibioperoneal trunk. This was
followed by 4 mm balloon angioplasty.
The distal right lower extremity arteriogram with runoff was
performed.
Mechanical thrombolyzes was performed throughout the length of
the left superficial femoral artery an additional time. A left
common femoral artery/superficial femoral arteriogram was
performed.
Repeat angioplasty and mechanical thrombolyzes was required in
the left superficial femoral artery and popliteal artery.
A 5 mm x 30 mm Metronic stent was deployed across the most
proximal portion of the left superficial femoral artery.
A followup arteriogram was performed.
A completion infrapopliteal left lower extremity arteriogram
was performed.
Once the ACT level reached below 175, the sheath was removed
and hemostasis was obtained with manual compression. The
patient tolerated the procedure well and left the department in
baseline condition.