Wiki Peripheral

[calorom2]

Can someone give me some guidance on this? I don't get these too frequently so any help would be appreciated!


PROCEDURE PERFORMED:
Left common femoral artery access, catheter placement, and contralateral
SFA 2nd order, diagnostic angiography with runoff.

COMPLICATIONS:
None.

INDICATION FOR PROCEDURE:
Ulceration, right 2nd toe; known peripheral arterial disease.

DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed in the left common femoral artery under ultrasound
guidance. Catheter was placed up and over. Selective angiography was
performed. The patient tolerated the procedure well. There were no
complications.

CONSCIOUS SEDATION TIME:
Thirty minutes.

ANGIOGRAPHIC FINDINGS:
Abdominal aorta, free of significant disease. There is calcification
in bilateral common and external iliacs, but no focal stenosis. The
right common femoral has heavily calcified lesion of 80% stenosis extending
into the profunda. The proximal SFA has a stent that is widely patent.
The entire SFA is guarded 10% to 20% diffuse calcified lesion. There
is another stent in the above knee popliteal, which is patent. Runoff
is via the anterior and posterior tibial. The posterior tibial goes
all the way into the foot. The anterior tibial is occluded just after
the ankle. The peroneal terminates at the level of the ankle.

IMPRESSION:
We did pressure pullback and there was a 40 mm gradient across the common
femoral.
Recommend common femoral endarterectomy. Further recommendations to
follow hospital course.

 

[sequester25@gmail.com]

I would start breaking the procedures down...

36620 - arterial catheterization

75710, 75716 - for the angiography, but a better one could be possible

76942, 76998 - possibly for ultrasound guideance

Maybe this will get you started and pointed in the right direction.

 

[Jim Pawloski]

Can someone give me some guidance on this? I don't get these too frequently so any help would be appreciated!


PROCEDURE PERFORMED:
Left common femoral artery access, catheter placement, and contralateral
SFA 2nd order, diagnostic angiography with runoff.

COMPLICATIONS:
None.

INDICATION FOR PROCEDURE:
Ulceration, right 2nd toe; known peripheral arterial disease.

DESCRIPTION OF PROCEDURE:
After informed consent, discussion of risks and benefits, a 5-French
sheath was placed in the left common femoral artery under ultrasound
guidance. Catheter was placed up and over. Selective angiography was
performed. The patient tolerated the procedure well. There were no
complications.

CONSCIOUS SEDATION TIME:
Thirty minutes.

ANGIOGRAPHIC FINDINGS:
Abdominal aorta, free of significant disease. There is calcification
in bilateral common and external iliacs, but no focal stenosis. The
right common femoral has heavily calcified lesion of 80% stenosis extending
into the profunda. The proximal SFA has a stent that is widely patent.
The entire SFA is guarded 10% to 20% diffuse calcified lesion. There
is another stent in the above knee popliteal, which is patent. Runoff
is via the anterior and posterior tibial. The posterior tibial goes
all the way into the foot. The anterior tibial is occluded just after
the ankle. The peroneal terminates at the level of the ankle.

IMPRESSION:
We did pressure pullback and there was a 40 mm gradient across the common
femoral.
Recommend common femoral endarterectomy. Further recommendations to
follow hospital course.

First, you need to see where the catheter went. The SFA is a 3rd order selective on the contralateral side to the puncture site. Second, is what did they look at. The Rt lower extremity was imaged. The pressure measurements are bundled into the procedure. So you should have 36247-RT, 75710. The other 36620 is for anesthesia department placement for arterial pressures, so do not use. Image of vascular access w/ ultrasound is not documented, so I would not billed 76937.

HTH,
Jim Pawloski, CIRCC