iamlou
Networker
Hi,
Can someone PLEASE help me with coding this scenario? I don't have much experience in these types of cases.
THANK YOU!!!!
PROCEDURES PERFORMED:
Diagnostic thoracic aortic arch aortography and selective left common
carotid artery angiography
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Descending thoracic aorta, left common carotid artery
TECHNIQUE: Under ultrasound guidance, the right common femoral artery was accessed. Over a guidewire
a 6 French sheath was inserted. Over the guidewire and through the sheath
a 5 French pigtail catheter was placed in the ascending thoracic aortic
arch. LAO arteriography was performed centered on the cervical neck
region. There is a type II transverse thoracic aortic arch, with common
origin of the left common carotid artery with the right brachiocephalic
artery. The diagnostic catheter was exchanged over a guidewire for a 5
French Simmons 2 glide catheter. The Simmons 2 catheter was formed over a
guidewire via the left subclavian artery in standard fashion. The Simmons
2 catheter was subsequently positioned within the origin of the left common
carotid artery. Selective injections were performed in the LAO, RAO and AP
projections with magnified views obtained at the level of the carotid
bifurcation.
There is a focal stenosis in the proximal ICA, approximately 1.5 cm distal
to the carotid bifurcation. The stenosis, using the NASCET criteria, is
approximately 60 percent. This is below the threshold for Sapphire trial
registry and CMS mandated 80 percent for asymptomatic patients. As such,
no intervention was performed. The catheter and sheath were removed. The
access site closed using Starr close without incident. Approximately 50 mL
of Omnipaque 300 were utilized for the procedure.
FINDINGS:
2 transverse thoracic aortic arch, trunked to the left common carotid
artery and right brachiocephalic artery, findings consistent with bovine
anatomy, normal variant. The right brachiocephalic artery, subclavian
artery, left subclavian arteries are widely patent. The left common
carotid artery is patent. There is a high-grade narrowing and very limited
filling of the left ECA. Surgical clips overlie the left carotid bulb.
There is a focal 60 percent stenosis in the proximal left ICA approximately
1.5 cm from distal to the carotid bifurcation. The imaged portion of the
left cervical ICA and Petrus ICA is widely patent. The right and left
vertebral arteries are patent. The right common carotid artery is patent.
There is a cervical kink in the right ICA. The right ECA is patent. No
intervention as described above.
Can someone PLEASE help me with coding this scenario? I don't have much experience in these types of cases.
THANK YOU!!!!
PROCEDURES PERFORMED:
Diagnostic thoracic aortic arch aortography and selective left common
carotid artery angiography
IMAGING MODALITY UTILIZED:
Ultrasound and fluoroscopy
ACCESS SITE:
Right common femoral artery
CATHETER POSITION:
Descending thoracic aorta, left common carotid artery
TECHNIQUE: Under ultrasound guidance, the right common femoral artery was accessed. Over a guidewire
a 6 French sheath was inserted. Over the guidewire and through the sheath
a 5 French pigtail catheter was placed in the ascending thoracic aortic
arch. LAO arteriography was performed centered on the cervical neck
region. There is a type II transverse thoracic aortic arch, with common
origin of the left common carotid artery with the right brachiocephalic
artery. The diagnostic catheter was exchanged over a guidewire for a 5
French Simmons 2 glide catheter. The Simmons 2 catheter was formed over a
guidewire via the left subclavian artery in standard fashion. The Simmons
2 catheter was subsequently positioned within the origin of the left common
carotid artery. Selective injections were performed in the LAO, RAO and AP
projections with magnified views obtained at the level of the carotid
bifurcation.
There is a focal stenosis in the proximal ICA, approximately 1.5 cm distal
to the carotid bifurcation. The stenosis, using the NASCET criteria, is
approximately 60 percent. This is below the threshold for Sapphire trial
registry and CMS mandated 80 percent for asymptomatic patients. As such,
no intervention was performed. The catheter and sheath were removed. The
access site closed using Starr close without incident. Approximately 50 mL
of Omnipaque 300 were utilized for the procedure.
FINDINGS:
2 transverse thoracic aortic arch, trunked to the left common carotid
artery and right brachiocephalic artery, findings consistent with bovine
anatomy, normal variant. The right brachiocephalic artery, subclavian
artery, left subclavian arteries are widely patent. The left common
carotid artery is patent. There is a high-grade narrowing and very limited
filling of the left ECA. Surgical clips overlie the left carotid bulb.
There is a focal 60 percent stenosis in the proximal left ICA approximately
1.5 cm from distal to the carotid bifurcation. The imaged portion of the
left cervical ICA and Petrus ICA is widely patent. The right and left
vertebral arteries are patent. The right common carotid artery is patent.
There is a cervical kink in the right ICA. The right ECA is patent. No
intervention as described above.