bevann0402@bellsouth.net
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My comments/codes are listed at the end. Any advice/help if going in the right direction or totally off base will be greatly appreciated.
Procedures performed:
1. 6-french sheath placement in the right common femoral artery, with the use of an Amplatz wire
2. 4-french sheath placement in the left common femoral artery without difficulty
3. selective angiography to the Right Common Femoral Artery
4. selective angiography to the Right External Iliac Artery
5. selective angiography to the Right Common Iliac Artery
6. selective angiography to the Left Common Iliac Artery
7. selective angiography to the Left Common Femoral Artery with runoff
8. Balloon angioplasty to the Right External Iliac Artery
9. percutaneous transluminal coronary angioplasty with stenting of the Right External Iliac Artery, utilizing EverFlex stent x2 with 90% lesion reduced to less than 10%.
indication: lifestyle limiting claudication, chronic limb ischemia and nonhealing wound t the left lower extremity.
the patient underwent a 6-french sheath placement to the Right Common Femoral Artery, utilizing an Amplatz wire. Please note that the right external iliac artery appeared to be 100% occluded in the midportion, but we know from previous angiography, that there is a small channel with is present to be visualized from the left common iliac artery.
next we placed a 4 French sheath to the left common femoral artery without difficulty.
we took a power catheter to perform initial angiography. initial angiography was performed of the right common femoral artery which is showing a widely patent right common femoral artery. the dye is seen up into the right external iliac artery, and then 100% occlusion is seen. next we took a 4 French IMA catheter placed it up into the ostium of the takeoff of the left common iliac artery, up and over to the Distal Aorta, and placed it in the right common iliac artery. Selective angiography was then performed which demonstrates that the right common iliac artery is patent. the right external iliac artery then has a large 90% occlusion seen to it, and then we go down into the rest of the right external iliac artery, down into the right common femoral artery as described above.
After both sheaths were in place, Angiomax was started. utilizing angiography from the left common iliac artery, we took a small prowater wire and carefully with the use of a roadmap, passed the wire through the small channel up into the aorta.
Imaging catheter was taken over the small Prowater wire, and placed into the Distal Aorta. The small prowater wire was then removed, and we exchanged this out for a long 0.032 wire.
next, we took a 6x40 evercross balloon, placed it across the severe lesion, and deployed it at 6 atmospheres for 30 seconds. next angiography was performed via the left groin, demonstrating the severe 90% lesion that is recied to about 50%. a non-flow-limiting dissection detected. the balloon was removed from the body. next an 8x40 everflex stent was placed across the predilatated area, and was self-deployed. some of the stent length was actually taken into the right internal iliac artery, and required placement of a second 8x20 everflex stent. this was self-expandingly deployed. following this , we posted the 2 stents with a 7x40 evercross balloon. the 90% lesion was reduced to less than 10% at the site of the right external iliac artery.
next selective angiography was completed of the right common iliac artery which was widely patent, the right external iliac artery is now patent with 2 stents noted. the right common femoral artery was widely patent, down into the right superficial femoral artery, and the proximal portion of it is widely patent.
next we performed selective angiography also to the left common iliac artery which was widely patent. there is moderate diffuse disease seen down into the right external iliac artery down into the left common femoral artery. the superficial femoral artery is 100% occluded in the proximal portion and there is single vessel runoff to the left foot via the posterior tibial artery. the Angiomax was discontinued. the introducer sheath was sewn into place and the patient was transferred to ICU to have his introducer sheath removed. patient scheduled for stage 3 procedure next week now that we have the ability to place a 6-8 French sheath in the right common femoral artery to go up and over the distal aorta down in to the left leg.
I got a 37221 RT, 36246/36247(?) for the left
Am I missing a code or two. I am a little confused on that.
Any help on figuring out the steps on picking the correct code will be helpful!!
Thanks
Beverly, CPC, CIMC
Procedures performed:
1. 6-french sheath placement in the right common femoral artery, with the use of an Amplatz wire
2. 4-french sheath placement in the left common femoral artery without difficulty
3. selective angiography to the Right Common Femoral Artery
4. selective angiography to the Right External Iliac Artery
5. selective angiography to the Right Common Iliac Artery
6. selective angiography to the Left Common Iliac Artery
7. selective angiography to the Left Common Femoral Artery with runoff
8. Balloon angioplasty to the Right External Iliac Artery
9. percutaneous transluminal coronary angioplasty with stenting of the Right External Iliac Artery, utilizing EverFlex stent x2 with 90% lesion reduced to less than 10%.
indication: lifestyle limiting claudication, chronic limb ischemia and nonhealing wound t the left lower extremity.
the patient underwent a 6-french sheath placement to the Right Common Femoral Artery, utilizing an Amplatz wire. Please note that the right external iliac artery appeared to be 100% occluded in the midportion, but we know from previous angiography, that there is a small channel with is present to be visualized from the left common iliac artery.
next we placed a 4 French sheath to the left common femoral artery without difficulty.
we took a power catheter to perform initial angiography. initial angiography was performed of the right common femoral artery which is showing a widely patent right common femoral artery. the dye is seen up into the right external iliac artery, and then 100% occlusion is seen. next we took a 4 French IMA catheter placed it up into the ostium of the takeoff of the left common iliac artery, up and over to the Distal Aorta, and placed it in the right common iliac artery. Selective angiography was then performed which demonstrates that the right common iliac artery is patent. the right external iliac artery then has a large 90% occlusion seen to it, and then we go down into the rest of the right external iliac artery, down into the right common femoral artery as described above.
After both sheaths were in place, Angiomax was started. utilizing angiography from the left common iliac artery, we took a small prowater wire and carefully with the use of a roadmap, passed the wire through the small channel up into the aorta.
Imaging catheter was taken over the small Prowater wire, and placed into the Distal Aorta. The small prowater wire was then removed, and we exchanged this out for a long 0.032 wire.
next, we took a 6x40 evercross balloon, placed it across the severe lesion, and deployed it at 6 atmospheres for 30 seconds. next angiography was performed via the left groin, demonstrating the severe 90% lesion that is recied to about 50%. a non-flow-limiting dissection detected. the balloon was removed from the body. next an 8x40 everflex stent was placed across the predilatated area, and was self-deployed. some of the stent length was actually taken into the right internal iliac artery, and required placement of a second 8x20 everflex stent. this was self-expandingly deployed. following this , we posted the 2 stents with a 7x40 evercross balloon. the 90% lesion was reduced to less than 10% at the site of the right external iliac artery.
next selective angiography was completed of the right common iliac artery which was widely patent, the right external iliac artery is now patent with 2 stents noted. the right common femoral artery was widely patent, down into the right superficial femoral artery, and the proximal portion of it is widely patent.
next we performed selective angiography also to the left common iliac artery which was widely patent. there is moderate diffuse disease seen down into the right external iliac artery down into the left common femoral artery. the superficial femoral artery is 100% occluded in the proximal portion and there is single vessel runoff to the left foot via the posterior tibial artery. the Angiomax was discontinued. the introducer sheath was sewn into place and the patient was transferred to ICU to have his introducer sheath removed. patient scheduled for stage 3 procedure next week now that we have the ability to place a 6-8 French sheath in the right common femoral artery to go up and over the distal aorta down in to the left leg.
I got a 37221 RT, 36246/36247(?) for the left
Am I missing a code or two. I am a little confused on that.
Any help on figuring out the steps on picking the correct code will be helpful!!
Thanks
Beverly, CPC, CIMC