bevann0402@bellsouth.net
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Even after going to a half day seminar, I am still confused, but needing to see if I am going in the right direction.. TIA (I put my answers at the bottom!!)
Procedure.
1. 6 french sheath placement in the Left Common Femoral Artery, w/o difficulty
2. distal aortagram with runoff
3. selective angiography of the right common iliac artery
4. selective angiography of the right external iliac artery
5. selective angiography of the right common femoral artery
6. selective angiography, with catheter placement to the right superficial femoral artery
7. selective angiography, with catheter placement to the right popliteal artery
8. catheter placement with selective angiography of the right anterior tibial artery
9. selective angiography with catheter placement to the right peritoneal artery
10. atherectomy utilizing turbohawk technology to the distal SFA, popliteal artery to the right lower extremity
11. suction thrombectomy to the right anterior tibial artery
12. suction thrombectomy to the right peritoneal artery
13 plain old balloon angioplasty of the right anterior tibial artery
14 selective angiography of the left common femoral artery
15 angio seal to the left common femoral artery. good hemostasis, no hematoma
16. cutting balloon atherectomy to the right anterior tibial artery, utilizing a 2.0x20mm AngioSculpt cutting balloon catheter.
indication: lifestyle limiting claudication, abnormal ABI, abnormal CTA
our attention was given to the left groin. fluoroscopy was used to isolate the left common femoral artery. the left common femoral artery was cannulated x 2 sticks. it was a difficult stick due to large pannus in an elderly female. stick is at the lower to mid femoral head, and angiography of the left common femoral artery showed a widely patent artery, widely patent profunda femoral artery, proximal superficial femoral artery on the right widely patent, right external iliac artery also appears to be widely patent.
next we took an IMA catheter over a Wholey wire, progressed up and over to the distal aorta. distal aorta angiography was performed and the runoff was to the Right Lower Extremity Only. Angiography detects that the right common iliac artery was widely patent. The right external iliac artery was widely patent. The right internal artery showed nonosbtructive disease of less than 30%. Next the IMA atheter was taken down into the right common femoral artery, right superficial femoral artery, and selective angiography was performed to determine mild plaque in the proximal and mid-SFA. there were areas greater than 70% stenosis noted at Hunter canal, in the very distal SFA, which continues down to the popliteal artery. Selective angiography of the popliteal and infrapopliteal trunk was performed. Popliteal artery had severe, greater than 70% lesion detected. the anterior tibial artery also noted tandem lesions, a total of 4 proximally. all severe lesions detected. the anterior tibial artery also had severe lesion, but this vessel does not travel to the foot, and stops midway down the leg, and then is recollateralized to the foot via itself. next, the decision was made to proceed with Atherectomy and angioplasty. we removed the IMA catheter and the 6 short sheath and exchanged out for a 6 french 45 cm Terumo sheath, which was placed up and over the aortic bifurcation, and goes down to land at the right common femoral artery. Angiomax was started, trailblazer catheter was then used to help deliver a 5-0 spider filter to the distal SFA popliteal turnck. Turbohawk SSXC atherectomy catheter was used. Atherectomy was performed to the distal SFA and the popliteal artery, with multiple passes being peformed. next we went to removed the 5-0 spider filter, to proceed down with the infrapopliteal trunk. the filter was removed, placed back into the catheter. there was dislodgement of several pieces of debris, one into the AT and one into the peritoneal trunk. to repair this, we place a 3-0 filter down past the debris on the right lower extremity. suction atherectomy was performed with a Fetch catheter and then the filter was pulled back. debris was found inthe filer device, and flow was returned to the area. next a 3-0 filter was placed in the peritoneal artery. suction atherectomy was performed and the filter was pulled back with a minimum amount of debris found.
next we had a small remaining residual lesion noted to the right anterior tibial artery. we took a 2.0x60 coyote balloon. this was elevated to 5 atmospheres for 2 minutes. then the catheter was removed. incomplete angiolasty was noted. we then took a 2.0 x 100 mm coyote balloon, placed it in the anterior tibial artery. inflation was a 5 atmospheres for 120 seconds. then the catheter was removed from the body. next continued residual apprecaited. we took a 2.0x20 angiosculpt cutting balloon catheter and cutting balloon atherectomy was performed across the anterior tibial artery at 14 atompsheres for 60 seconds, 14 atmospheres for 60 seconds, and 8 atmospheres for 60 seconds. next the catheter was removed from the body. we used a trailblazer catheter to recover our spider filter and angiography was performed with and without the wire in place. the severe lesions to the SFA, popliteal trunk, and the anterior tibial artery are all less than 20%, at this point and would be considered an adequate atherectomy and angioplasty result. please note that we did perform complete angioplasty at the close of the case and watched the runoff to the level of the foot to ensure that we had continued in-line flow down to the level of the foot. next the Terumo sheath was removed from the body over a Wholey wire, was was changed out to a 6 french short sheath. we then placed a 6 french angio seal to the left common femoral artery with good hemostasis.
what should i get out of this (75710, 75625, 2 possibly 3- 75774?? need to query the doctor-he is not clear about selective catheter placement of the anterior tibial artery)
37225, 37228
I also have to ask him the TurboHawk atherectomy catheter.
I am a little stuck with how many codes I need to have???!!
Thanks
Beverly, CPC, CIMC
Procedure.
1. 6 french sheath placement in the Left Common Femoral Artery, w/o difficulty
2. distal aortagram with runoff
3. selective angiography of the right common iliac artery
4. selective angiography of the right external iliac artery
5. selective angiography of the right common femoral artery
6. selective angiography, with catheter placement to the right superficial femoral artery
7. selective angiography, with catheter placement to the right popliteal artery
8. catheter placement with selective angiography of the right anterior tibial artery
9. selective angiography with catheter placement to the right peritoneal artery
10. atherectomy utilizing turbohawk technology to the distal SFA, popliteal artery to the right lower extremity
11. suction thrombectomy to the right anterior tibial artery
12. suction thrombectomy to the right peritoneal artery
13 plain old balloon angioplasty of the right anterior tibial artery
14 selective angiography of the left common femoral artery
15 angio seal to the left common femoral artery. good hemostasis, no hematoma
16. cutting balloon atherectomy to the right anterior tibial artery, utilizing a 2.0x20mm AngioSculpt cutting balloon catheter.
indication: lifestyle limiting claudication, abnormal ABI, abnormal CTA
our attention was given to the left groin. fluoroscopy was used to isolate the left common femoral artery. the left common femoral artery was cannulated x 2 sticks. it was a difficult stick due to large pannus in an elderly female. stick is at the lower to mid femoral head, and angiography of the left common femoral artery showed a widely patent artery, widely patent profunda femoral artery, proximal superficial femoral artery on the right widely patent, right external iliac artery also appears to be widely patent.
next we took an IMA catheter over a Wholey wire, progressed up and over to the distal aorta. distal aorta angiography was performed and the runoff was to the Right Lower Extremity Only. Angiography detects that the right common iliac artery was widely patent. The right external iliac artery was widely patent. The right internal artery showed nonosbtructive disease of less than 30%. Next the IMA atheter was taken down into the right common femoral artery, right superficial femoral artery, and selective angiography was performed to determine mild plaque in the proximal and mid-SFA. there were areas greater than 70% stenosis noted at Hunter canal, in the very distal SFA, which continues down to the popliteal artery. Selective angiography of the popliteal and infrapopliteal trunk was performed. Popliteal artery had severe, greater than 70% lesion detected. the anterior tibial artery also noted tandem lesions, a total of 4 proximally. all severe lesions detected. the anterior tibial artery also had severe lesion, but this vessel does not travel to the foot, and stops midway down the leg, and then is recollateralized to the foot via itself. next, the decision was made to proceed with Atherectomy and angioplasty. we removed the IMA catheter and the 6 short sheath and exchanged out for a 6 french 45 cm Terumo sheath, which was placed up and over the aortic bifurcation, and goes down to land at the right common femoral artery. Angiomax was started, trailblazer catheter was then used to help deliver a 5-0 spider filter to the distal SFA popliteal turnck. Turbohawk SSXC atherectomy catheter was used. Atherectomy was performed to the distal SFA and the popliteal artery, with multiple passes being peformed. next we went to removed the 5-0 spider filter, to proceed down with the infrapopliteal trunk. the filter was removed, placed back into the catheter. there was dislodgement of several pieces of debris, one into the AT and one into the peritoneal trunk. to repair this, we place a 3-0 filter down past the debris on the right lower extremity. suction atherectomy was performed with a Fetch catheter and then the filter was pulled back. debris was found inthe filer device, and flow was returned to the area. next a 3-0 filter was placed in the peritoneal artery. suction atherectomy was performed and the filter was pulled back with a minimum amount of debris found.
next we had a small remaining residual lesion noted to the right anterior tibial artery. we took a 2.0x60 coyote balloon. this was elevated to 5 atmospheres for 2 minutes. then the catheter was removed. incomplete angiolasty was noted. we then took a 2.0 x 100 mm coyote balloon, placed it in the anterior tibial artery. inflation was a 5 atmospheres for 120 seconds. then the catheter was removed from the body. next continued residual apprecaited. we took a 2.0x20 angiosculpt cutting balloon catheter and cutting balloon atherectomy was performed across the anterior tibial artery at 14 atompsheres for 60 seconds, 14 atmospheres for 60 seconds, and 8 atmospheres for 60 seconds. next the catheter was removed from the body. we used a trailblazer catheter to recover our spider filter and angiography was performed with and without the wire in place. the severe lesions to the SFA, popliteal trunk, and the anterior tibial artery are all less than 20%, at this point and would be considered an adequate atherectomy and angioplasty result. please note that we did perform complete angioplasty at the close of the case and watched the runoff to the level of the foot to ensure that we had continued in-line flow down to the level of the foot. next the Terumo sheath was removed from the body over a Wholey wire, was was changed out to a 6 french short sheath. we then placed a 6 french angio seal to the left common femoral artery with good hemostasis.
what should i get out of this (75710, 75625, 2 possibly 3- 75774?? need to query the doctor-he is not clear about selective catheter placement of the anterior tibial artery)
37225, 37228
I also have to ask him the TurboHawk atherectomy catheter.
I am a little stuck with how many codes I need to have???!!
Thanks
Beverly, CPC, CIMC
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