antoniamay
Networker
I am really confused on this procedure - because it is being referred to by different procedure names and I am just truly unsure what I can code. This is the procedure details.
Mechanical thrombectomy:
71 YO male came with LMCA syndrome, CTH with no bleeding. CTP showed large core with 55 ml of mismatch.
Technique:
Part A: Diagnostic angiography with selective catheterization of following vessels:
1. Left common carotid artery, frontal and lateral views of the neck.
2. Left internal carotid artery, frontal and lateral views of the head.
3. Left internal carotid artery, frontal and lateral views centered on the left MCA bifurcation.
4. Microinjection at the LICA terminus
4. Right common femoral artery angiogram, frontal views.
Procedure Report:
Informed consent: The benefits, risks, and alternatives for the procedure, informed consent was obtained from the patient's family. The risks including, but not limited to; stroke, intracranial hemorrhage, vascular injury to the cervical or femoral vessels, and groin hematoma were discussed.
A. Diagnostic Angiography
Both groins were draped and prepped in a sterile fashion. Using the modified Seldinger technique and a micropuncture system, an 8 French long femoral sheath was placed in the right common femoral artery.
Using the modified Seldinger technique and a micropuncture system, a 8 French long femoral sheath was placed in the right common femoral artery and used as an intra-arterial line.
Then, an 8 French guide catheter was navigated over a Terumo 0.035" Glidewire into the aortic arch under fluoroscopic guidance.
Under fluoroscopy, the catheter was placed into the left common carotid artery and frontal and lateral views were acquired. The catheter was then advanced into the left internal carotid artery followed by frontal and lateral view angiograms of the head/neck.
FINDINGS:
1. There is an occlusion of LICA close to the origin
2. LICA occlusion intracranial next to the PcomA
3. Multiple distal embolism clots to the PcomA, ophthalmic artery and within the carotid artery
Right common femoral artery angiogram: Normal course and caliber of the right common femoral artery. The arteriotomy sites are midway between the takeoff of the inferior epigastric artery and the femoral bifurcation in a segment of vessel that is more than 5 mm in diameter.
Part B: Endovascular Treatment: Mechanical thrombectomy/LICA stenting and LACA aspiration
The guide catheter zoom 88 was then navigated within the common carotid artery, select catheter was used to cross the LICA occlusion. Magnified frontal and lateral angiograms of the head, via selec catheter contrast injection, centered on the LICA were obtained.
Using Terumo .035'' exchange catheter was attempted to exchange the select catheter out. After 2 attempts, 0.014" exchange microguidewire was used and select cathter was replaced with Precise stent 8 mm x 40 mm.
Next, Via triaxial technique, zoom 71 aspiration catheter was navigated over a phenome 21 microcatheter and aristotle 0.018" microguidewire, into the left ACA. The system keep herniation, then Via triaxial technique, using 3Max this time. the 3Max microcatheter was navigated, over Aristotle 0.018" microguidewire, into the A2 segment of the left ACA. .
Then, under fluoroscopy, the microcatheter aspiration catheter was allowed to integrated with the clot for 3 minutes. Under constant aspiration The aspiration catheter withdrawn.
Follow-up frontal and lateral angiograms of the head were performed, demonstrating some recanalization of the ICA occlusion (TICI-2A ), with multiple distal embolism.
After the endovascular intracranial mechanical thrombectomy/aspiration procedure, 8 French angio-seal closure device was placed at the right common femoral artery access site. Adequate hemostasis was achieved. The sites were cleansed and a sterile dressing was applied.
Complications: None.
IMPRESSION:
Impression
- 1 pass (TICI-2A) using aspiration
- S/p LICA stenting
- Multiple distal clots, LM1 remain occluded
Can I code 36224, 36227, is it 35301 or then 64615?
Mechanical thrombectomy:
71 YO male came with LMCA syndrome, CTH with no bleeding. CTP showed large core with 55 ml of mismatch.
Technique:
Part A: Diagnostic angiography with selective catheterization of following vessels:
1. Left common carotid artery, frontal and lateral views of the neck.
2. Left internal carotid artery, frontal and lateral views of the head.
3. Left internal carotid artery, frontal and lateral views centered on the left MCA bifurcation.
4. Microinjection at the LICA terminus
4. Right common femoral artery angiogram, frontal views.
Procedure Report:
Informed consent: The benefits, risks, and alternatives for the procedure, informed consent was obtained from the patient's family. The risks including, but not limited to; stroke, intracranial hemorrhage, vascular injury to the cervical or femoral vessels, and groin hematoma were discussed.
A. Diagnostic Angiography
Both groins were draped and prepped in a sterile fashion. Using the modified Seldinger technique and a micropuncture system, an 8 French long femoral sheath was placed in the right common femoral artery.
Using the modified Seldinger technique and a micropuncture system, a 8 French long femoral sheath was placed in the right common femoral artery and used as an intra-arterial line.
Then, an 8 French guide catheter was navigated over a Terumo 0.035" Glidewire into the aortic arch under fluoroscopic guidance.
Under fluoroscopy, the catheter was placed into the left common carotid artery and frontal and lateral views were acquired. The catheter was then advanced into the left internal carotid artery followed by frontal and lateral view angiograms of the head/neck.
FINDINGS:
1. There is an occlusion of LICA close to the origin
2. LICA occlusion intracranial next to the PcomA
3. Multiple distal embolism clots to the PcomA, ophthalmic artery and within the carotid artery
Right common femoral artery angiogram: Normal course and caliber of the right common femoral artery. The arteriotomy sites are midway between the takeoff of the inferior epigastric artery and the femoral bifurcation in a segment of vessel that is more than 5 mm in diameter.
Part B: Endovascular Treatment: Mechanical thrombectomy/LICA stenting and LACA aspiration
The guide catheter zoom 88 was then navigated within the common carotid artery, select catheter was used to cross the LICA occlusion. Magnified frontal and lateral angiograms of the head, via selec catheter contrast injection, centered on the LICA were obtained.
Using Terumo .035'' exchange catheter was attempted to exchange the select catheter out. After 2 attempts, 0.014" exchange microguidewire was used and select cathter was replaced with Precise stent 8 mm x 40 mm.
Next, Via triaxial technique, zoom 71 aspiration catheter was navigated over a phenome 21 microcatheter and aristotle 0.018" microguidewire, into the left ACA. The system keep herniation, then Via triaxial technique, using 3Max this time. the 3Max microcatheter was navigated, over Aristotle 0.018" microguidewire, into the A2 segment of the left ACA. .
Then, under fluoroscopy, the microcatheter aspiration catheter was allowed to integrated with the clot for 3 minutes. Under constant aspiration The aspiration catheter withdrawn.
Follow-up frontal and lateral angiograms of the head were performed, demonstrating some recanalization of the ICA occlusion (TICI-2A ), with multiple distal embolism.
After the endovascular intracranial mechanical thrombectomy/aspiration procedure, 8 French angio-seal closure device was placed at the right common femoral artery access site. Adequate hemostasis was achieved. The sites were cleansed and a sterile dressing was applied.
Complications: None.
IMPRESSION:
Impression
- 1 pass (TICI-2A) using aspiration
- S/p LICA stenting
- Multiple distal clots, LM1 remain occluded
Can I code 36224, 36227, is it 35301 or then 64615?