bevann0402@bellsouth.net
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TIA. I just want to make sure of this one. It is slightly different than one I have had before.
I came up with 37227-LT; 75716-26; and the more I look at this, I think I am missing at least one more code.
procedures:
1. 6-french sheath placement in the right common femoral artery w/o difficulty
2. distal aortogram with bilateral extremity runoff
3. selective angiography of the left common femoral artery
4. selective angiography of the left superficial femoral artery
5. selective angiography of the left popliteal trunk
6. selective angiography of the right common femoral artery
7. atherectomy with balloon angioplasty to the left superficial femoral artery and the proximal portion of the left popliteal artery.
indication: lifestyle limiting claudication, abnormal CTA with runoff
Procedure:
the details of lower extremity angiography and angioplasty with atherectomy were explained to the patient in detail, including risk factors. patient underwent 6-french sheath placement in the right common femoral artery w/o difficulty. we then took a pigtail catheter placed into the distal aorta and distal aortogram with bilateral lower extremity runoff was performed.
the distal aorta shows some mild distal tapering, and mild calcification is present. angiography was as follows.
right common iliac artery was widely patent, with mild calcifications.
right internal iliac artery shows a 90% ostial lesion.
right external iliac artery widely patent.
right common femoral artery 30% diffuse stenosis seen.
right superficial femoral artery diffuse 70% stenosis in the midportion, heavily calcified.
the right popliteal demonstrated a clean vessel, and 3-vessel runoff to the right foot was noted.
the patient underwent angiography of left lower extremity. left common iliac artery widely patent. the left internal iliac artery widely patent. left external iliac artery widely patent. left common femoral artery mild diffuse disease, small calcifications.
left superficial femoral artery. there is chronic total occlusion noted ostially, with reconstitution to the proximal popliteal artery.
left popliteal artery just showing mild diffuse disease of less than 30%. three-vessel runoff to the left foo..
the case was then converted to angioplasty. we removed the 6-french sheath in the right common femoral artery and placed a 7x45 terumo sheath and took it down into the takeoff of the left superficial femoral artery. we then took a viance catheter supported by a grand slam wire and placed this into the cap of the left superficial femoral artery. extensive manipulation was performed, but unable to cross. the viance catheter was then removed from the body.
next we took a trailblazer, utilizing an angled glide wire and placed this down into the crook of the left superficial femoral artery and with some time and manipulation of the catheter we were able to cross the proximal and distal calf and place the wire down into the left popliteal artery. at this point we changed out for the angled glide to a prowater wire. the trailblazer was ultimately removed, and we placed a 7-french spider down into the left popliteal artery. next a turbohawk lx-c was used and extensive drain atherectomy was performed from the ostial left superficial femoral artery all way down into the proximal left popliteal artery. extensive debulking atherectomy was required.
following this we took a 5x220 sterling balloon and we smoothed out the areas starting from the ostial left superficial femoral artery down into the very distal left superficial femoral artery, total of 3 inflations, each at 4 atmospheres for 2 minutes. at the completion of this we took a 5x16mm mustang, placed it in the distal left superficial femoral artery, elevated it to 5 atmospheres for 2 minutes. final angiography was performed with and without wire in place. the chronic total occlusion to the left superficial femoral artery now is reduced to less than 30%.
at the close of the case we removed the 7x45 terumo and replaced it with a 7-french short sheath. patient was transferred to ICU for monitoring post conscious sedation.
patient now recommended stage 2 procedure to the right superficial femoral artery and this will be performed at a later date. as noted above patient left lab chest-pain free, no hematoma.
thanks for all the help,
beverly
I came up with 37227-LT; 75716-26; and the more I look at this, I think I am missing at least one more code.
procedures:
1. 6-french sheath placement in the right common femoral artery w/o difficulty
2. distal aortogram with bilateral extremity runoff
3. selective angiography of the left common femoral artery
4. selective angiography of the left superficial femoral artery
5. selective angiography of the left popliteal trunk
6. selective angiography of the right common femoral artery
7. atherectomy with balloon angioplasty to the left superficial femoral artery and the proximal portion of the left popliteal artery.
indication: lifestyle limiting claudication, abnormal CTA with runoff
Procedure:
the details of lower extremity angiography and angioplasty with atherectomy were explained to the patient in detail, including risk factors. patient underwent 6-french sheath placement in the right common femoral artery w/o difficulty. we then took a pigtail catheter placed into the distal aorta and distal aortogram with bilateral lower extremity runoff was performed.
the distal aorta shows some mild distal tapering, and mild calcification is present. angiography was as follows.
right common iliac artery was widely patent, with mild calcifications.
right internal iliac artery shows a 90% ostial lesion.
right external iliac artery widely patent.
right common femoral artery 30% diffuse stenosis seen.
right superficial femoral artery diffuse 70% stenosis in the midportion, heavily calcified.
the right popliteal demonstrated a clean vessel, and 3-vessel runoff to the right foot was noted.
the patient underwent angiography of left lower extremity. left common iliac artery widely patent. the left internal iliac artery widely patent. left external iliac artery widely patent. left common femoral artery mild diffuse disease, small calcifications.
left superficial femoral artery. there is chronic total occlusion noted ostially, with reconstitution to the proximal popliteal artery.
left popliteal artery just showing mild diffuse disease of less than 30%. three-vessel runoff to the left foo..
the case was then converted to angioplasty. we removed the 6-french sheath in the right common femoral artery and placed a 7x45 terumo sheath and took it down into the takeoff of the left superficial femoral artery. we then took a viance catheter supported by a grand slam wire and placed this into the cap of the left superficial femoral artery. extensive manipulation was performed, but unable to cross. the viance catheter was then removed from the body.
next we took a trailblazer, utilizing an angled glide wire and placed this down into the crook of the left superficial femoral artery and with some time and manipulation of the catheter we were able to cross the proximal and distal calf and place the wire down into the left popliteal artery. at this point we changed out for the angled glide to a prowater wire. the trailblazer was ultimately removed, and we placed a 7-french spider down into the left popliteal artery. next a turbohawk lx-c was used and extensive drain atherectomy was performed from the ostial left superficial femoral artery all way down into the proximal left popliteal artery. extensive debulking atherectomy was required.
following this we took a 5x220 sterling balloon and we smoothed out the areas starting from the ostial left superficial femoral artery down into the very distal left superficial femoral artery, total of 3 inflations, each at 4 atmospheres for 2 minutes. at the completion of this we took a 5x16mm mustang, placed it in the distal left superficial femoral artery, elevated it to 5 atmospheres for 2 minutes. final angiography was performed with and without wire in place. the chronic total occlusion to the left superficial femoral artery now is reduced to less than 30%.
at the close of the case we removed the 7x45 terumo and replaced it with a 7-french short sheath. patient was transferred to ICU for monitoring post conscious sedation.
patient now recommended stage 2 procedure to the right superficial femoral artery and this will be performed at a later date. as noted above patient left lab chest-pain free, no hematoma.
thanks for all the help,
beverly