ccbouchard
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I work for a billing company. I deal strictly with pediatrics and internal medicine. My boss has decided he wants to branch out to specialty fields. He has brought on a doctor specializing in vascular and interventional radiology. I have never dealt with this area of coding, however, they have asked me to tell them how the following procedure can be coded and how much Medicare will pay. I have no clue where to begin when reading this report. Can someone please help me with this?? I am coming up with CPT 35475....Am I anywhere close to where I need to be?
confused:
PROCEDURE IN DETAIL:
After informed consent was obtained, the patient's access was prepped and draped in the appropriate sterile manner.
Access was accomplished with a micro access system in the direction of the venous outflow using ultrasound guidance
because of the scar tissue about the access making palpation of the access difficult. Ultrasound of the access
demonstrates it to be patent. A digital image was captured and stored on the digital archive. A second separate arterially
directed point of access was needed and created. Once accessed, a coaxial dilator was placed and through this dilator, a
complete fistulagram was performed. There is a diminished thrill at the region of the arterial anastomosis and at the
juxta-anastomotic segment. Thus, it was decided to investigate the inflow. A glidewire and Berenstein catheter were
used to selectively catheterize the brachial artery. The catheter was positioned upstream to the arterial anastomosis. A
brachial arteriogram was performed to evaluate for poor flow, arterial stenosis, or embolus.
FINDINGS:
The fistulagram demonstrates no evidence of stenosis in the Juxta-anastomotic Segment, Lower Arm Basilic Vein, Mid
Arm Basilic Vein, Upper Arm Basilic Vein, Axillary Basilic Junction, Axillary Vein, Subclavian Vein, and SVC.
The brachial artery inflow is patent without stenosis or embolus but there is a 50% stenosis was observed in the arterial
anastomosis. The visualized portion of the right brachial artery distal to the anastomosis is patent without a significant
stenosis. A 60% in-stent stenosis was observed in the brachiocephalic vein.
INTERVENTIONS:
The arterial anastomosis stenosis was treated with angioplasty using a standard balloon, size 6 x4. The post
intervention stenosis was less than 10%. The brachiocephalic vein in-stent stenosis was treated with angioplasty using
a standard balloon, size 12 x4. The post intervention stenosis was less than 10%.
confused:PROCEDURE IN DETAIL:
After informed consent was obtained, the patient's access was prepped and draped in the appropriate sterile manner.
Access was accomplished with a micro access system in the direction of the venous outflow using ultrasound guidance
because of the scar tissue about the access making palpation of the access difficult. Ultrasound of the access
demonstrates it to be patent. A digital image was captured and stored on the digital archive. A second separate arterially
directed point of access was needed and created. Once accessed, a coaxial dilator was placed and through this dilator, a
complete fistulagram was performed. There is a diminished thrill at the region of the arterial anastomosis and at the
juxta-anastomotic segment. Thus, it was decided to investigate the inflow. A glidewire and Berenstein catheter were
used to selectively catheterize the brachial artery. The catheter was positioned upstream to the arterial anastomosis. A
brachial arteriogram was performed to evaluate for poor flow, arterial stenosis, or embolus.
FINDINGS:
The fistulagram demonstrates no evidence of stenosis in the Juxta-anastomotic Segment, Lower Arm Basilic Vein, Mid
Arm Basilic Vein, Upper Arm Basilic Vein, Axillary Basilic Junction, Axillary Vein, Subclavian Vein, and SVC.
The brachial artery inflow is patent without stenosis or embolus but there is a 50% stenosis was observed in the arterial
anastomosis. The visualized portion of the right brachial artery distal to the anastomosis is patent without a significant
stenosis. A 60% in-stent stenosis was observed in the brachiocephalic vein.
INTERVENTIONS:
The arterial anastomosis stenosis was treated with angioplasty using a standard balloon, size 6 x4. The post
intervention stenosis was less than 10%. The brachiocephalic vein in-stent stenosis was treated with angioplasty using
a standard balloon, size 12 x4. The post intervention stenosis was less than 10%.