bevann0402@bellsouth.net
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I thought the following note was going to be pretty straightforward, but I am second guessing myself. My doctor is now getting back into doing leg procedures now that the holidays are over and I am having a little trouble getting my groove back!! lol
Thanks in advance for the help!
indication: nonhealing wound to the left foot, with chronic limb ischemia and patient needing limb salvage procedure
procedures performed:
1. 4-french sheath placement into the right common femoral artery
2. 6 French sheath placement to the left common femoral artery
3. selective angiography to the right common iliac artery
4. selective angiography of the right common femoral artery
5. selective angiography of the right external iliac artery
6. distal aortogram with bilateral lower extremity runoff
informed consent signed and witnessed after details explained. transferred to coronary suite, prepped and draped. he underwent 4-french sheath placement in the right common femoral artery, with a mild amount of difficulty.
ANGIOGRAPHY: selective angiography was then performed. the right external iliac artery was 100% occluded in the mid portion, but no dye goes proximally. The runoff is seen via the groin. the right profunda femoral artery was widely patent.
the right superficial femoral artery is patent, with 40% mid disease.
non-flow-limiting dissection seen at Hunter canal.
the right popliteal artery is occluded distally, with reconstitution to the right posterior tibial artery, with single vessel runoff to the right foot.
since we were unable to see the pelvic vessels, we then placed a 6-french sheath in the left common femoral artery without difficulty. the a 6-french pigtail was taken into the distal aorta and distal aortogram with bilaterial lower extremity runoff was performed.
the distal aorta is intact, with some mild calcifications. we were then able to see the takeoff of the right common iliac artery, which was patent, as well as the takeoff of the right external iliac artery, which was occluded, with a short CTO occlusion noted. please note that the right common iliac and the right external iliac artery are seen via access from the left groin.
following this, we completed his angiography. please see below for left leg. the left common iliac artery showed 30% diffuse disease.
left external iliac artery is aneurysmal, with 30% disease noted.
left common femoral artery has 50% diffuse disease.
left porfundus femoral artery, large, widely patent.
left superficial femoral artery 100% proximal occluded, with long occlusion extending down to Hunter canal, where it reconstitutes. There is severe disease seen to the left popliteal artery, and this goes down to a single vessel via the PT, which is not transverse to the foot.
we had attempted to go ahead and repair the right common iliac artery. we were going to up-size the 4-french sheath to a 6-french sheath. there was a bend in the wire and we were unable to proceed, and I lost wire position to the right groin. the case was halted, since we were unable to give anticoagulation, with a hole now in the right common femoral artery. pressure was held without hematoma or incidents noted. vas-cath catheter was placed outside the artery, to the left common femoral artery with good hemostasis. no hematoma. the patient had only faint dopplerable pulses to the left foot and these were unchanged post procedure. I did see the patient in the ambulatory setting with some mild erythema noted but no change in skin condition or Doppler. patient was able to move foot and had sensation. the decision has been made now that we will proceed with repair to the right external iliac artery, to go ahead and maintain inline flow.
After I re-read again, He started with the placement in the right common femoral and did not move from the vessel entered. That would be Code 36140.
but then he stuck the left side. This is where I am getting confused.
My aortogram - CPT 75630-26-59
Any advice on how to get where I need to be will be greatly appreciated. I do not expect ya'll just to give me the answers! I have the most trouble with these leg cases, (selective, non-selective, etc)
Thanks
Beverly Abernathy, CPC, CIMC
Thanks in advance for the help!
indication: nonhealing wound to the left foot, with chronic limb ischemia and patient needing limb salvage procedure
procedures performed:
1. 4-french sheath placement into the right common femoral artery
2. 6 French sheath placement to the left common femoral artery
3. selective angiography to the right common iliac artery
4. selective angiography of the right common femoral artery
5. selective angiography of the right external iliac artery
6. distal aortogram with bilateral lower extremity runoff
informed consent signed and witnessed after details explained. transferred to coronary suite, prepped and draped. he underwent 4-french sheath placement in the right common femoral artery, with a mild amount of difficulty.
ANGIOGRAPHY: selective angiography was then performed. the right external iliac artery was 100% occluded in the mid portion, but no dye goes proximally. The runoff is seen via the groin. the right profunda femoral artery was widely patent.
the right superficial femoral artery is patent, with 40% mid disease.
non-flow-limiting dissection seen at Hunter canal.
the right popliteal artery is occluded distally, with reconstitution to the right posterior tibial artery, with single vessel runoff to the right foot.
since we were unable to see the pelvic vessels, we then placed a 6-french sheath in the left common femoral artery without difficulty. the a 6-french pigtail was taken into the distal aorta and distal aortogram with bilaterial lower extremity runoff was performed.
the distal aorta is intact, with some mild calcifications. we were then able to see the takeoff of the right common iliac artery, which was patent, as well as the takeoff of the right external iliac artery, which was occluded, with a short CTO occlusion noted. please note that the right common iliac and the right external iliac artery are seen via access from the left groin.
following this, we completed his angiography. please see below for left leg. the left common iliac artery showed 30% diffuse disease.
left external iliac artery is aneurysmal, with 30% disease noted.
left common femoral artery has 50% diffuse disease.
left porfundus femoral artery, large, widely patent.
left superficial femoral artery 100% proximal occluded, with long occlusion extending down to Hunter canal, where it reconstitutes. There is severe disease seen to the left popliteal artery, and this goes down to a single vessel via the PT, which is not transverse to the foot.
we had attempted to go ahead and repair the right common iliac artery. we were going to up-size the 4-french sheath to a 6-french sheath. there was a bend in the wire and we were unable to proceed, and I lost wire position to the right groin. the case was halted, since we were unable to give anticoagulation, with a hole now in the right common femoral artery. pressure was held without hematoma or incidents noted. vas-cath catheter was placed outside the artery, to the left common femoral artery with good hemostasis. no hematoma. the patient had only faint dopplerable pulses to the left foot and these were unchanged post procedure. I did see the patient in the ambulatory setting with some mild erythema noted but no change in skin condition or Doppler. patient was able to move foot and had sensation. the decision has been made now that we will proceed with repair to the right external iliac artery, to go ahead and maintain inline flow.
After I re-read again, He started with the placement in the right common femoral and did not move from the vessel entered. That would be Code 36140.
but then he stuck the left side. This is where I am getting confused.
My aortogram - CPT 75630-26-59
Any advice on how to get where I need to be will be greatly appreciated. I do not expect ya'll just to give me the answers! I have the most trouble with these leg cases, (selective, non-selective, etc)
Thanks
Beverly Abernathy, CPC, CIMC