suela923@aol.com
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I have coded the following report as: 75625-59, 75716-59, 37220, 37221 (I am using mod 59 for now instead of the newer modifiers). Would someone please read this and see if they agree with billing for the 37220 which is on the left side while the 37221 is on the right. Normally we would see stents placed on both sides and my tech is saying she has never seen just plasty done to one side and stent on the other. Do you feel this is coded correctly?
Thanks so much,
Sue
Procedure: Aortoiliac angiogram. Bilateral lower extremity runoff.
Indication: Rest pain and ulceration right lower extremity.
Results: Patient was identified and brought to the vascular unit. The left and right groins were prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the left femoral artery. An angiographic needle, wire, and 5-French sheath were then placed. A flush catheter was placed at the level of the renal arteries. Using DSA and power injection aortoiliac angiography was obtained. The catheter was then brought down to the aortic bifurcation and additional views of the pelvis were obtained in RAO and LAO projection. A bilateral lower extremity runoff was then obtained using a bolus chase technique.
Findings of this study are as follows: Single patent renal arteries bilaterally. No stenoses is seen. Infrarenal aorta is patent and free of occlusive disease.
Right leg runoff reveals an occluded right common iliac artery within a stented segment. There is reconstitution of a distal common iliac artery as well as the internal and external iliac artery on the right which appear to be patent without stenoses. The right common femoral and deep femoral arteries appear to be patent without stenoses. The right SFA is patent without stenoses. The popliteal artery is patent above and below the knee. There appears to be three-vessel runoff to the right foot through the anterior tibial, posterior tibial, and peroneal arteries.
Left leg runoff shows patent common iliac, external iliac, and internal iliac arteries. The left common femoral and deep femoral arteries are patent without stenoses. The left superficial femoral artery is patent without significant stenoses. The popliteal artery is patent above and below the knee. There appears to be three-vessel runoff to the left foot through the anterior tibial, posterior tibial, and peroneal arteries.
Previous angiography had been performed, however there is a significant change in the patient's clinical condition since prior angiography necessitating a new and complete study. The decision to intervene is based on the current diagnostic study.
Patient was heparinized with 9000 units of intravenous heparin. A flush catheter was left in the infrarenal aorta through the left femoral artery. Additional access was obtained through the right femoral artery, A 6-French sheath was placed in the right femoral artery using a Seldinger technique. A frontrunner device was used to traverse the chronic total occlusion in the right common iliac artery. Intraluminal access in the aorta was confirmed with angiography. A 0.035 guidewire was then placed through this stenotic lesion. Balloon angioplasty was performed to 5 mm to facilitate stent placement. A 8 mm x 39 mm balloon expandable Genesis stent was placed inside the previous existing stent. A 8 mm balloon was utilized in the left common iliac artery for contralateral support. This was done over a 0.035 guidewire. An additional self-expanding stent was placed in the distal right common iliac artery. This was 9 mm x 60 mm Nitinol self-expanding SMART stent. Subsequently this was dilated to 7 mm with a balloon. Completion study showed patency of the stented iliac segment without residual stenoses present. Multiple oblique views were obtained showing excellent flow through the right and left iliac system. There is excellent flow into the common femoral arteries. At the completion of the case both sheaths were removed and the right and left groin were sealed with a closure device. The patient tolerated the procedure well and left in stable condition.
Result Impression
Chronic total occlusion of the right common iliac artery primarily treated with stent placement with good result.
Thanks so much,
Sue
Procedure: Aortoiliac angiogram. Bilateral lower extremity runoff.
Indication: Rest pain and ulceration right lower extremity.
Results: Patient was identified and brought to the vascular unit. The left and right groins were prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the left femoral artery. An angiographic needle, wire, and 5-French sheath were then placed. A flush catheter was placed at the level of the renal arteries. Using DSA and power injection aortoiliac angiography was obtained. The catheter was then brought down to the aortic bifurcation and additional views of the pelvis were obtained in RAO and LAO projection. A bilateral lower extremity runoff was then obtained using a bolus chase technique.
Findings of this study are as follows: Single patent renal arteries bilaterally. No stenoses is seen. Infrarenal aorta is patent and free of occlusive disease.
Right leg runoff reveals an occluded right common iliac artery within a stented segment. There is reconstitution of a distal common iliac artery as well as the internal and external iliac artery on the right which appear to be patent without stenoses. The right common femoral and deep femoral arteries appear to be patent without stenoses. The right SFA is patent without stenoses. The popliteal artery is patent above and below the knee. There appears to be three-vessel runoff to the right foot through the anterior tibial, posterior tibial, and peroneal arteries.
Left leg runoff shows patent common iliac, external iliac, and internal iliac arteries. The left common femoral and deep femoral arteries are patent without stenoses. The left superficial femoral artery is patent without significant stenoses. The popliteal artery is patent above and below the knee. There appears to be three-vessel runoff to the left foot through the anterior tibial, posterior tibial, and peroneal arteries.
Previous angiography had been performed, however there is a significant change in the patient's clinical condition since prior angiography necessitating a new and complete study. The decision to intervene is based on the current diagnostic study.
Patient was heparinized with 9000 units of intravenous heparin. A flush catheter was left in the infrarenal aorta through the left femoral artery. Additional access was obtained through the right femoral artery, A 6-French sheath was placed in the right femoral artery using a Seldinger technique. A frontrunner device was used to traverse the chronic total occlusion in the right common iliac artery. Intraluminal access in the aorta was confirmed with angiography. A 0.035 guidewire was then placed through this stenotic lesion. Balloon angioplasty was performed to 5 mm to facilitate stent placement. A 8 mm x 39 mm balloon expandable Genesis stent was placed inside the previous existing stent. A 8 mm balloon was utilized in the left common iliac artery for contralateral support. This was done over a 0.035 guidewire. An additional self-expanding stent was placed in the distal right common iliac artery. This was 9 mm x 60 mm Nitinol self-expanding SMART stent. Subsequently this was dilated to 7 mm with a balloon. Completion study showed patency of the stented iliac segment without residual stenoses present. Multiple oblique views were obtained showing excellent flow through the right and left iliac system. There is excellent flow into the common femoral arteries. At the completion of the case both sheaths were removed and the right and left groin were sealed with a closure device. The patient tolerated the procedure well and left in stable condition.
Result Impression
Chronic total occlusion of the right common iliac artery primarily treated with stent placement with good result.