I need help with peripherals. This is the procedure my doctor performed.
Conscious sedation for 80 minutes from 11:23 AM to 12:43 PM, left lower extremity angiogram, left popliteal orbital atherectomy, left popliteal PTA with a DCB, selective AT angiogram, right common femoral angiogram, Perclose closure device of the right common femoral artery.
Patient was brought to the cardiac catheterization lab where she was prepped and draped in the usual sterile fashion. Using ultrasound guidance 2% lidocaine was used to infiltrate the right groin region for local anesthesia. Under continued ultrasound guidance a 5 French micropuncture set was inserted into the right common femoral artery and exchanged out eventually for a standard 6 French short sheath. A right common femoral angiogram was performed and showed arteriotomy that was adequate for closure device. We first advanced an IMA 5 French catheter over standard J-tipped wire and parked the catheter at the aortic bifurcation. The J-tipped wire was removed and we did advance a advantage glide 0.035 wire which continued to maneuver into the internal iliac artery. The advantage Glidewire was positioned in the descending aorta and the IMA guiding catheter was removed. We then exchanged the 6 French short sheath for a 6 French destination 45 cm sheath. Through this we advanced a 5 French Omni Flush catheter and this did direct the Glidewire advantage down into the external iliac artery. Using a "telescoping" technique the destination sheath was advanced to the left common femoral artery. IV heparin was given following removal of the glidewire advantage and Omni catheter. Left lower extremity angiography was performed. After confirmed therapeutic ACT a CXI catheter along with 0.014"x300cm Command ES wire was used to cross the distal SFA and popliteal disease and parked in the distal anterior tibial artery. Angiography was performed through the CXI catheter to confirm intraluminal position. The Command wire was removed and the CSI Viper wire was then readvanced into the anterior tibial artery. The CXI catheter was removed and we then proceeded with orbital atherectomy using the diamondback CSI Solid crown 2.0 mm system. We performed multiple runs from the distal SFA to the P2 region of the popliteal. This included 2 passes at 60 RPMs followed by 2 passes at 90 RPMs and 1 Final Pass at 120 RPMs for around 25-30 seconds per run. The CSI diamondback was then removed and selective SFA and AT angiogram were performed showing the debulking of her stenosis. We then proceeded with a 4.0x80 mm compliant balloon was advanced across the occlusion and inflated multiple times. The compliant balloon was removed and angiography was performed. Stellerex 5.0x120mm drug coated balloon was placed, prepped and inflated for 3 minute inflation to cover the lesion. There was confirmed TIMI-3 flow distally with anticipation that the drug-coated balloons would continue with patency. The patient was noted to have improved runoff infrapopliteal compared to preprocedurally and the wire was removed. Following this angiography was performed without the wire the destination sheath was pulled back to the right common iliac. A standard 038 inch J-tipped guidewire was used to advance into the aorta remove the destination sheath in place a Perclose in the usual manner without incident. The patient tolerated the procedure well and was transferred to PACU in a stable condition. Procedural findings below:
Angiographic Findings:
Right iliofemoral vasculature: Mild diffuse disease
Left lower extremity:
Profunda: patent
Superficial femoral artery: Distal long 70% stenosis leading into the P1 segment
Popliteal artery: 100% occlusion at the P2 segment. After intervention reduction to 0% with very distal P3 60-70% stenosis just prior to the bifurcation of the AT and TPT.
Anterior tibial: Patent
Peroneal: Patent
Posterior tibial: Patent
I am a little confused on whether to bill for the anterior tibial angiogram and left lower extremity angiogram.
Thank you for any help on this.
Are the codes: 37225, 75710-2659, 76937-26
Conscious sedation for 80 minutes from 11:23 AM to 12:43 PM, left lower extremity angiogram, left popliteal orbital atherectomy, left popliteal PTA with a DCB, selective AT angiogram, right common femoral angiogram, Perclose closure device of the right common femoral artery.
Patient was brought to the cardiac catheterization lab where she was prepped and draped in the usual sterile fashion. Using ultrasound guidance 2% lidocaine was used to infiltrate the right groin region for local anesthesia. Under continued ultrasound guidance a 5 French micropuncture set was inserted into the right common femoral artery and exchanged out eventually for a standard 6 French short sheath. A right common femoral angiogram was performed and showed arteriotomy that was adequate for closure device. We first advanced an IMA 5 French catheter over standard J-tipped wire and parked the catheter at the aortic bifurcation. The J-tipped wire was removed and we did advance a advantage glide 0.035 wire which continued to maneuver into the internal iliac artery. The advantage Glidewire was positioned in the descending aorta and the IMA guiding catheter was removed. We then exchanged the 6 French short sheath for a 6 French destination 45 cm sheath. Through this we advanced a 5 French Omni Flush catheter and this did direct the Glidewire advantage down into the external iliac artery. Using a "telescoping" technique the destination sheath was advanced to the left common femoral artery. IV heparin was given following removal of the glidewire advantage and Omni catheter. Left lower extremity angiography was performed. After confirmed therapeutic ACT a CXI catheter along with 0.014"x300cm Command ES wire was used to cross the distal SFA and popliteal disease and parked in the distal anterior tibial artery. Angiography was performed through the CXI catheter to confirm intraluminal position. The Command wire was removed and the CSI Viper wire was then readvanced into the anterior tibial artery. The CXI catheter was removed and we then proceeded with orbital atherectomy using the diamondback CSI Solid crown 2.0 mm system. We performed multiple runs from the distal SFA to the P2 region of the popliteal. This included 2 passes at 60 RPMs followed by 2 passes at 90 RPMs and 1 Final Pass at 120 RPMs for around 25-30 seconds per run. The CSI diamondback was then removed and selective SFA and AT angiogram were performed showing the debulking of her stenosis. We then proceeded with a 4.0x80 mm compliant balloon was advanced across the occlusion and inflated multiple times. The compliant balloon was removed and angiography was performed. Stellerex 5.0x120mm drug coated balloon was placed, prepped and inflated for 3 minute inflation to cover the lesion. There was confirmed TIMI-3 flow distally with anticipation that the drug-coated balloons would continue with patency. The patient was noted to have improved runoff infrapopliteal compared to preprocedurally and the wire was removed. Following this angiography was performed without the wire the destination sheath was pulled back to the right common iliac. A standard 038 inch J-tipped guidewire was used to advance into the aorta remove the destination sheath in place a Perclose in the usual manner without incident. The patient tolerated the procedure well and was transferred to PACU in a stable condition. Procedural findings below:
Angiographic Findings:
Right iliofemoral vasculature: Mild diffuse disease
Left lower extremity:
Profunda: patent
Superficial femoral artery: Distal long 70% stenosis leading into the P1 segment
Popliteal artery: 100% occlusion at the P2 segment. After intervention reduction to 0% with very distal P3 60-70% stenosis just prior to the bifurcation of the AT and TPT.
Anterior tibial: Patent
Peroneal: Patent
Posterior tibial: Patent
I am a little confused on whether to bill for the anterior tibial angiogram and left lower extremity angiogram.
Thank you for any help on this.
Are the codes: 37225, 75710-2659, 76937-26
