Elizabeth83
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Our doctors commonly do these procedures, and since the new bundling of the aortic arch angio codes I've had a hard time deciding whether i should be billing something for the arch aortogram and injections at the subclavian. Ultimately i feel like the main problem is in the arm, but i don't want to undercode the procedure either. I can't seem to find any hard evidence on how to bill it. Thank you
POSTOPERATIVE DIAGNOSIS: Arterial steal, right upper extremity, with
gangrenous tip of right third finger
PROCEDURES:
1. Percutaneous access, right common femoral artery.
2. Insertion of catheter into ascending aorta.
3. Arch aortogram.
4. Advancement of catheter to right axillary artery with additional
angiograms of right upper extremity with and without compression of the
arteriovenous fistula.
5. Deployment of Mynx device, right groin
Informed consent was obtained. The patient was
brought to the radiology suite. A time out was performed. The right groin
was prepped and draped. IV sedation was given. One percent lidocaine was
infiltrated. A needle was inserted into the right common femoral artery
using palpation only. A wire was passed under fluoroscopic guidance up
into the aorta. 5-French sheath was introduced. A pigtail catheter was
then inserted over the wire to the ascending aorta. An arch aortogram was
performed. Over a Glidewire I exchanged over to a JV-2 catheter, which was
used to access the innominate artery. The Glidewire was then passed down
to the right axillary artery and the catheter advanced to that location.
Additional angiograms of the of the right upper extremity were then
performed. There was only some flow going distal to the fistula, so in the
forearm and hand, only angiograms were done with compression of the fistula
in order to get enough dye to evaluate he arterial anatomy. At the end the
catheter was removed and a Mynx device deployed in the right groin using
standard techniques. Pressure was applied. The patient tolerated the
procedure well.
FINDINGS: No significant narrowing was noted at the origin of the great
vessels. The right subclavian, axillary and brachial arteries appeared
widely patent to the level of the fistula. There may be some narrowing at
the level of the brachial artery at the antecubital fossa. In the forearm
the ulnar artery does terminate early. The radial artery is the dominant
artery going down to the hand feeding the arch with some mild to moderate,
distal small vessel disease noted.
POSTOPERATIVE DIAGNOSIS: Arterial steal, right upper extremity, with
gangrenous tip of right third finger
PROCEDURES:
1. Percutaneous access, right common femoral artery.
2. Insertion of catheter into ascending aorta.
3. Arch aortogram.
4. Advancement of catheter to right axillary artery with additional
angiograms of right upper extremity with and without compression of the
arteriovenous fistula.
5. Deployment of Mynx device, right groin
Informed consent was obtained. The patient was
brought to the radiology suite. A time out was performed. The right groin
was prepped and draped. IV sedation was given. One percent lidocaine was
infiltrated. A needle was inserted into the right common femoral artery
using palpation only. A wire was passed under fluoroscopic guidance up
into the aorta. 5-French sheath was introduced. A pigtail catheter was
then inserted over the wire to the ascending aorta. An arch aortogram was
performed. Over a Glidewire I exchanged over to a JV-2 catheter, which was
used to access the innominate artery. The Glidewire was then passed down
to the right axillary artery and the catheter advanced to that location.
Additional angiograms of the of the right upper extremity were then
performed. There was only some flow going distal to the fistula, so in the
forearm and hand, only angiograms were done with compression of the fistula
in order to get enough dye to evaluate he arterial anatomy. At the end the
catheter was removed and a Mynx device deployed in the right groin using
standard techniques. Pressure was applied. The patient tolerated the
procedure well.
FINDINGS: No significant narrowing was noted at the origin of the great
vessels. The right subclavian, axillary and brachial arteries appeared
widely patent to the level of the fistula. There may be some narrowing at
the level of the brachial artery at the antecubital fossa. In the forearm
the ulnar artery does terminate early. The radial artery is the dominant
artery going down to the hand feeding the arch with some mild to moderate,
distal small vessel disease noted.
