shescka
Contributor
Hello 
Can I code this with 37236 alone?? is it the rght code?
thank you experts
PROCEDURE PERFORMED:
Left renal artery stenting with a 7.0 x 15 mm Express SD stent.
PROCEDURE INDICATION:
Worsened chronic renal insufficiency.
BRIEF HISTORY:
This is a 74-year-old male with worsening renal insufficiency for
which the patient has been on dialysis for the last 6 weeks who was
found to have in- stent restenosis and bilateral renal artery stents
on angiogram 2 days ago, is now referred for elective renal
angioplasty.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion and under moderate sedation. local anesthesia with 2% lidocaine .
A 6-French
sheath was placed in the right femoral artery and angiogram confirmed
normal sheath positioning, after which a 6-French sheath LIMA guide
catheter was used to engage the left renal artery over a 5-French
multipurpose catheter through which a short BMW wire was passed into
the left renal artery. The in-stent stenosis in the left renal artery
was ballooned with a 2.5 x 12 mm NC balloon after which a 4.0 x 12 mm
NC balloon was used to pre-dilate the lesion followed by a 4.5 x 12 mm
NC balloon. We then successfully deployed a 7 x 15 mm Express SD renal
stent in the left renal artery to 8 atmospheres and then ballooned the
ostium near the abdominal aorta, to 10 atmospheres. This gave a
favorable angiographic result with good stent apposition and no
evidence of dissection. The in- stent stenosis of 90 percent prior to
the angioplasty was reduced to 0 percent post angioplasty. There were
no complications during the procedure and the patient tolerated the
procedure well. The patient also had a right groin 4-French MS sheath
placed in the right femoral vein for venous access during the
procedure. Both sheaths were secured in place to be removed by manual
compression in the holding room. We were also unsuccessful in engaging
the right renal artery with the 6-French IM guide catheter or with 6-
French JR4 guide catheter, and were unsuccessful in passing a BMW wire
into the right renal artery due to which angioplasty was not performed
in this vessel. Also IV heparin was administered during the procedure
to maintain adequate anticoagulation.
POSTOPERATIVE DIAGNOSIS:
Successful left renal artery stent placement with a 7.5 x 15 mm
Express SD renal stent.
PLAN OF CARE:
1. Monitor renal function.
2. Consider angioplasty to the right renal artery if the renal
function does not improve.
3. Continue dual antiplatelet therapy.
Can I code this with 37236 alone?? is it the rght code?
thank you experts
PROCEDURE PERFORMED:
Left renal artery stenting with a 7.0 x 15 mm Express SD stent.
PROCEDURE INDICATION:
Worsened chronic renal insufficiency.
BRIEF HISTORY:
This is a 74-year-old male with worsening renal insufficiency for
which the patient has been on dialysis for the last 6 weeks who was
found to have in- stent restenosis and bilateral renal artery stents
on angiogram 2 days ago, is now referred for elective renal
angioplasty.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion and under moderate sedation. local anesthesia with 2% lidocaine .
A 6-French
sheath was placed in the right femoral artery and angiogram confirmed
normal sheath positioning, after which a 6-French sheath LIMA guide
catheter was used to engage the left renal artery over a 5-French
multipurpose catheter through which a short BMW wire was passed into
the left renal artery. The in-stent stenosis in the left renal artery
was ballooned with a 2.5 x 12 mm NC balloon after which a 4.0 x 12 mm
NC balloon was used to pre-dilate the lesion followed by a 4.5 x 12 mm
NC balloon. We then successfully deployed a 7 x 15 mm Express SD renal
stent in the left renal artery to 8 atmospheres and then ballooned the
ostium near the abdominal aorta, to 10 atmospheres. This gave a
favorable angiographic result with good stent apposition and no
evidence of dissection. The in- stent stenosis of 90 percent prior to
the angioplasty was reduced to 0 percent post angioplasty. There were
no complications during the procedure and the patient tolerated the
procedure well. The patient also had a right groin 4-French MS sheath
placed in the right femoral vein for venous access during the
procedure. Both sheaths were secured in place to be removed by manual
compression in the holding room. We were also unsuccessful in engaging
the right renal artery with the 6-French IM guide catheter or with 6-
French JR4 guide catheter, and were unsuccessful in passing a BMW wire
into the right renal artery due to which angioplasty was not performed
in this vessel. Also IV heparin was administered during the procedure
to maintain adequate anticoagulation.
POSTOPERATIVE DIAGNOSIS:
Successful left renal artery stent placement with a 7.5 x 15 mm
Express SD renal stent.
PLAN OF CARE:
1. Monitor renal function.
2. Consider angioplasty to the right renal artery if the renal
function does not improve.
3. Continue dual antiplatelet therapy.