bevann0402@bellsouth.net
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I have been looking at this report for the last two days until my eyes have crossed. Since I have just started coding for this physician (never done cardiology before this), this has been the most detailed, extensive op note and I want to make sure I am understanding.
I will put my answers and questions I have at the end of the op note. Thanks in advance for your input. As always it is most appreciated.
indications: abnormal ABI's, abnormal CTA, lifestyle limiting claudication
Procedures performed:
1. 6 French sheath placement in the right common femoral artery w/o difficulty
2. distal aortogram with bilateral lower extremity runoff
3. selective angiography of left iliac artery
4. selective angiography of left common femoral artery
5. selective angiography of left superficial femoral artery
6. selective angiography of left popliteal artery
7. selective angiography of left anterior tibial artery
8. selective angiography of left posterior tibial artery
9. selective angiography of the PT trunk
10. selective angiography of the right common femoral artery
11. atherectomy to the mid distal left superficial femoral artery utilizinf TurboHawk LS-C technology
12. percutaneous transluminal angioplasty of the distal left superficial femoral artery at the site of the Hunter canal post atherectomy
13 atherectomy to the proximal PT trunk utilizing TurboHawk sS-C technology
14. atherectomy to the left posterior tibial artery utilizing TurboHawk SS-C technology
complications: all procedures, none
the details of lower extremity angiography and angioplasty were explained to the patient in great detail including the risk factors. patient prepped and underwent 6 French sheath placement in right common femoral artery w/o difficulty. a 6 French pigtail was placed into the distal aorta and distal aortogram with runoff was performed. distal aorta showing some mild tapering, but no stenosis, no evidence of dissection.
right common iliac artery widely patent
right external iliac artery widely patent
right internal iliac artery widely patent
left common iliac artery widely patent
left external iliac artery widely patent
left internal iliac artery widely patent
runoff to the right foot demonstrating severe 70% lesion to the right superficial femoral artery and the infrapopliteal trunk.
imaging detecting severe lesion to the distal left superficial femoral artery at the site of Hunter canal, severe lesion of the TP trunk, and severe lesion of the distal PT.
decision was made to perform angioplasty to the left leg since we had a right groin stick. agniomax was started, we replaced the 6 French sheath catheter with a 7 French Terumo sheath. imaging was performed utilizing TrailBlazer catheter. once imaging was complete, the left leg SFA was wired in its entirety utilizing a Prowater wire. next, we took down an eV3 turbohawk LS-C device and placed it into the distal SFA at the site of the Hunter canal. five passes were performed. the 70% lesion reduced to less than 10%. mild irregularities noted. we took a 5x40 eV3 evercross balloon, deployed it across atherectomy area for 3 minutes. angiography with and without wire in place showing the 70% lesion reduced to less than 10%. next we removed this from the body and we used a Prowater coronary wire to wire the PT trunk, which had a severe 80% to 90% lesion. atherectomy was performed utilizing Turbohawk SS-C technology. several passes with final angiography with and without wire in place. severe lesion of 70% to 80% reduced to less than 10%. next we turned our attention and wired the posterior tibial artery utilizing a prowater wire, and again using Turbohawk SS-C technology, severe lesion results in less than 10% to 20% restenosis noted.
at the close of the case, right common femoral artery angiography is performed, demonstrating a widely patent vessel. decision was made to sew sheath into place. patient transferred from the lab and recommendation to proceed with a right lower extremity angioplasty at a later date once the kidneys have recovered.
1. the two abbreviations used:
TP-I found this one-stands for tibioperoneal trunk (I think)
PT (not sure, lol) still learning all the parts!!
2. I picked cpt codes: 37227,37229
I get confused on the aortograms: don't know if I need 75630 or if I use 75625 and 75716
Am I on the right track, missing a code, etc?
Thanks again!!
Beverly, CPC
I will put my answers and questions I have at the end of the op note. Thanks in advance for your input. As always it is most appreciated.
indications: abnormal ABI's, abnormal CTA, lifestyle limiting claudication
Procedures performed:
1. 6 French sheath placement in the right common femoral artery w/o difficulty
2. distal aortogram with bilateral lower extremity runoff
3. selective angiography of left iliac artery
4. selective angiography of left common femoral artery
5. selective angiography of left superficial femoral artery
6. selective angiography of left popliteal artery
7. selective angiography of left anterior tibial artery
8. selective angiography of left posterior tibial artery
9. selective angiography of the PT trunk
10. selective angiography of the right common femoral artery
11. atherectomy to the mid distal left superficial femoral artery utilizinf TurboHawk LS-C technology
12. percutaneous transluminal angioplasty of the distal left superficial femoral artery at the site of the Hunter canal post atherectomy
13 atherectomy to the proximal PT trunk utilizing TurboHawk sS-C technology
14. atherectomy to the left posterior tibial artery utilizing TurboHawk SS-C technology
complications: all procedures, none
the details of lower extremity angiography and angioplasty were explained to the patient in great detail including the risk factors. patient prepped and underwent 6 French sheath placement in right common femoral artery w/o difficulty. a 6 French pigtail was placed into the distal aorta and distal aortogram with runoff was performed. distal aorta showing some mild tapering, but no stenosis, no evidence of dissection.
right common iliac artery widely patent
right external iliac artery widely patent
right internal iliac artery widely patent
left common iliac artery widely patent
left external iliac artery widely patent
left internal iliac artery widely patent
runoff to the right foot demonstrating severe 70% lesion to the right superficial femoral artery and the infrapopliteal trunk.
imaging detecting severe lesion to the distal left superficial femoral artery at the site of Hunter canal, severe lesion of the TP trunk, and severe lesion of the distal PT.
decision was made to perform angioplasty to the left leg since we had a right groin stick. agniomax was started, we replaced the 6 French sheath catheter with a 7 French Terumo sheath. imaging was performed utilizing TrailBlazer catheter. once imaging was complete, the left leg SFA was wired in its entirety utilizing a Prowater wire. next, we took down an eV3 turbohawk LS-C device and placed it into the distal SFA at the site of the Hunter canal. five passes were performed. the 70% lesion reduced to less than 10%. mild irregularities noted. we took a 5x40 eV3 evercross balloon, deployed it across atherectomy area for 3 minutes. angiography with and without wire in place showing the 70% lesion reduced to less than 10%. next we removed this from the body and we used a Prowater coronary wire to wire the PT trunk, which had a severe 80% to 90% lesion. atherectomy was performed utilizing Turbohawk SS-C technology. several passes with final angiography with and without wire in place. severe lesion of 70% to 80% reduced to less than 10%. next we turned our attention and wired the posterior tibial artery utilizing a prowater wire, and again using Turbohawk SS-C technology, severe lesion results in less than 10% to 20% restenosis noted.
at the close of the case, right common femoral artery angiography is performed, demonstrating a widely patent vessel. decision was made to sew sheath into place. patient transferred from the lab and recommendation to proceed with a right lower extremity angioplasty at a later date once the kidneys have recovered.
1. the two abbreviations used:
TP-I found this one-stands for tibioperoneal trunk (I think)
PT (not sure, lol) still learning all the parts!!
2. I picked cpt codes: 37227,37229
I get confused on the aortograms: don't know if I need 75630 or if I use 75625 and 75716
Am I on the right track, missing a code, etc?
Thanks again!!
Beverly, CPC