Wiki Ir stent iliac artery, unilateral, initial vessel

[suela923@aol.com]

Hi, I need some help on this one please!
I am looking to bill:
36247 Rt Bypass Graft
75630
75774
37221

or 36247
75625
75710
37221

Thanks in advance for any help!!


Procedure: Aortoiliac angiogram. Left iliac artery stent placement. Right leg angiogram.
Indication: Possible bypass graft stenoses.

Results: Patient was identified and brought to the vascular unit. The left groin was prepped and draped in the usual sterile fashion; 2% lidocaine was used to infiltrate the skin over the left common femoral artery. An angiographic needle, wire, and 5-French sheath were then placed. A pigtail marker catheter was placed to the level of the renal arteries. Using DSA and power injection aortoiliac angiography was obtained. Catheter was then pulled down to the aortic bifurcation and bilateral oblique views of the pelvis were obtained. The findings of this study are as follows.

Single renal artery on the left no stenosis seen. Two renal arteries on the right no stenosis seen. Infrarenal abdominal aorta is patent and free of occlusive disease but it is aneurysmal. The left common iliac artery is patent and the left internal iliac artery is patent, the left external iliac artery has a severe stenosis at its origin. The left common femoral artery is patent.

The right common iliac, internal iliac, and external iliac arteries are patent. The right common femoral artery and profunda femoris arteries are patent. The patient's condition has changed since the prior exam necessitating a new complete arteriogram. The decision to intervene is based on the current study. I decided to stent the left external iliac artery lesion in order to facilitate catheter passage. The patient was systemically heparinized with 6000 units of heparin. The 5-French sheath was then exchanged out for a 6-French sheath. A Storq wire was placed through lesion. The left iliac lesion was primarily stented with a 9 mm x 40 mm self-expanding stent. Balloon angioplasty was performed with a 7 mm balloon. Excellent result was obtained on completion study. Next a VS1 catheter was then placed up and over the aortic bifurcation with its tip in the right common iliac artery. I was able to place this catheter up and over the aortic bifurcation but I exchanged it out for a Vert catheter and placed this in the right common femoral artery then right femoral-popliteal bypass graft. Right leg angiography shows occlusion of the native SFA. The femoral-popliteal bypass graft is patent without evidence of occlusive disease. It has its distal anastomosis in the popliteal artery below the knee. The tibioperoneal trunk is diffusely diseased with mild-to-moderate stenosis. The anterior tibial artery is patent proximally then occludes in the distal calf. The peroneal artery occluded in the mid calf. The posterior tibial artery is patent down to the ankle and then occludes. There is reconstitution of a dorsalis pedis artery via a peroneal collateral. At the completion of the case the heparin was reversed with protamine until the ACT was less than 200. The sheath was removed and manual pressure was held for 15 minutes without hematoma. Patient tolerated the procedure well and left in stable condition.

IMPRESSION:


Infrarenal abdominal aortic aneurysm. Severe stenosis left external iliac artery primarily stented with excellent result. Patent right leg bypass graft with no stenosis but distal progression of disease is present. Native right SFA is occluded

 

[dimmitta]

Here is what I would bill for this case:

37221 - Stent Left iliac
75625 - Aortogram
75716 - bilateral extremity study
75774 - selective right extremity study from rt com fem catheter placement

You lose the cath placement cpt when you do any intervention, unless cath & interventions were done via sep access sites. It reads to me like doctor did a classic high/low and then a more selective of the rt lower extremity with cath positioned over bifurcation into rt common femoral artery. Findings below the knee support this angiogram. Hope this helps!