ttglasscock
Networker
Which code is appropriate 0238T (iliac artery atherectomy) or 37184/37186 thrombectomy? I originally coded it with 0238T but now I'm not so sure.
HELP Please.
Additionally, diagnostic angiogram on 7/30/24 reveals high grade bilateral iliac stenoses (partially protective) with thrombus in iliacs, IN-Stent-Restenosis and right CFA dissection noted on US and angio.
PROCEDURE: Aortoiliac and BLE angiogram.
PRE PROCEDURE DIAGNOSIS: claudication, advanced PAD, rest pain, arterial dissection, arterial thrombus
POST PROCEDURE DIAGNOSIS: same, iliac/CFA stenoses
PROCEDURES PERFORMED:
1. US guided distal retrograde bilateral anterior tibial artery access and 6f sheaths.
2. Catheter into aorta from bilateral AT access.
3. Aortoiliac and bilateral leg runoff.
4. Bilateral iliacs and aorta mechanical thrombectomy with aspiration for thrombus in stent stenosis with using Rotarex followed with 6mm balloon angioplasty.
5. Right CFA Atherectomy using Rotarex followed by 6mm angioplasty for 70% in stent restenosis.
6. Left CFA Atherectomy using Rotarex device followed by 6mm angioplasty for 75% in stent restenosis.
7. Manual pressure
TECHNICAL/FINDINGS:
The benefits and potential risks of the procedure were explained to the patient and written informed consent was obtained. A full "Time-Out" procedure was performed using standard guidelines. The patient was placed supine on the fluoroscopy table and the bilateral ankles were prepped and draped in the usual sterile fashion. Following local anesthesia with 1% lidocaine the bilateral anterior tibial artery was accessed under ultrasound guidance with a micropunture set retrograde. A permanent sonographic image was stored for documentation. This was exchanged over a guidewire for a 6 French sheath.
035 wire into aorta from bilateral access then right leg sheath tip proximal SFA. Left short sheath remains. Catheter into aorta from bilateral access with angiogram.
DIAGNOSTIC/FRINDINGS:
There is Extensive mural thrombus/filling defects in aorta. One kissing stent overlaps the origin of a different stent due to the length discrepancy of the 2 stents. Kissing stents cephalad to approximately L2 level.
The Right and Left Common Iliacs each have a 95% In-Stent Re-stenoses. Thrombus is present in both bilaterally.
Left proximal external iliac has an 80% stenosis.
The Right external iliac has a 95% stenosis with eccentric non flow limiting dissection,
The Right CFA has in-stent restenosis of 70%,
The Left CFA has in-stent restenosis of 75%.
LEFT LE: The Left popliteal, anterior tibial artery, posterior tibial artery, and peroneal artery are all patent. The Posterior tibial artery dominant.
RIGHT LE: The Right popliteal, anterior tibial artery, posterior tibial artery, and peroneal artery are all patent. The Posterior tibial artery is dominant
Intervention:
Given component of thrombus present in the iliacs, At access was utilized bilaterally. An 018 wires system advanced into aorta from bilateral AT access.
A Rotarex atherectomy device was used to perform mechanical thrombectomy within aortic kissing stents in the iliac bilaterally. The thrombus was successfully aspirated with the mechanical thrombectomy. Atherectomy was also performed using the Rotarex device in the Right Common Femoral artery stent to treat the 70% in stent restenosis. Three passes performed using the device.
This was followed by 6mm x 200mm simultaneous balloon angioplasty spanning the aorta just cephalad to the stent origin all the way through the right CFA.
Atherectomy was also performed using the Rotarex device in the Left Common Femoral artery stent to treat the 75% in stent restenosis. Three passes performed using the device. This was followed by 6mm x 200mm simultaneous balloon angioplasty spanning aorta just cephalad to the stent origin all the way through the Left CFA.
Balloon angioplasty with extended inflation 6mm was performed to the right Common Femoral Artery for dissection.
Post intervention - there is dramatically improved in flow, no residual flow limiting stenosis.
Catheter injection in suprarenal aorta fills bilateral iliacs/CFA/SFA. There is no sign of outflow obstruction.
IA nitro administered, sheaths carefully removed, pressure held.
IMPRESSION:
1. Extensive in flow disease treated with combination of thrombectomy, atherectomy, angioplasty as above. No residual in flow stenosis.
2. Right CFA dissection treated with extended 6mm angioplasty/inflation. No flow limitation.
HELP Please.
Additionally, diagnostic angiogram on 7/30/24 reveals high grade bilateral iliac stenoses (partially protective) with thrombus in iliacs, IN-Stent-Restenosis and right CFA dissection noted on US and angio.
PROCEDURE: Aortoiliac and BLE angiogram.
PRE PROCEDURE DIAGNOSIS: claudication, advanced PAD, rest pain, arterial dissection, arterial thrombus
POST PROCEDURE DIAGNOSIS: same, iliac/CFA stenoses
PROCEDURES PERFORMED:
1. US guided distal retrograde bilateral anterior tibial artery access and 6f sheaths.
2. Catheter into aorta from bilateral AT access.
3. Aortoiliac and bilateral leg runoff.
4. Bilateral iliacs and aorta mechanical thrombectomy with aspiration for thrombus in stent stenosis with using Rotarex followed with 6mm balloon angioplasty.
5. Right CFA Atherectomy using Rotarex followed by 6mm angioplasty for 70% in stent restenosis.
6. Left CFA Atherectomy using Rotarex device followed by 6mm angioplasty for 75% in stent restenosis.
7. Manual pressure
TECHNICAL/FINDINGS:
The benefits and potential risks of the procedure were explained to the patient and written informed consent was obtained. A full "Time-Out" procedure was performed using standard guidelines. The patient was placed supine on the fluoroscopy table and the bilateral ankles were prepped and draped in the usual sterile fashion. Following local anesthesia with 1% lidocaine the bilateral anterior tibial artery was accessed under ultrasound guidance with a micropunture set retrograde. A permanent sonographic image was stored for documentation. This was exchanged over a guidewire for a 6 French sheath.
035 wire into aorta from bilateral access then right leg sheath tip proximal SFA. Left short sheath remains. Catheter into aorta from bilateral access with angiogram.
DIAGNOSTIC/FRINDINGS:
There is Extensive mural thrombus/filling defects in aorta. One kissing stent overlaps the origin of a different stent due to the length discrepancy of the 2 stents. Kissing stents cephalad to approximately L2 level.
The Right and Left Common Iliacs each have a 95% In-Stent Re-stenoses. Thrombus is present in both bilaterally.
Left proximal external iliac has an 80% stenosis.
The Right external iliac has a 95% stenosis with eccentric non flow limiting dissection,
The Right CFA has in-stent restenosis of 70%,
The Left CFA has in-stent restenosis of 75%.
LEFT LE: The Left popliteal, anterior tibial artery, posterior tibial artery, and peroneal artery are all patent. The Posterior tibial artery dominant.
RIGHT LE: The Right popliteal, anterior tibial artery, posterior tibial artery, and peroneal artery are all patent. The Posterior tibial artery is dominant
Intervention:
Given component of thrombus present in the iliacs, At access was utilized bilaterally. An 018 wires system advanced into aorta from bilateral AT access.
A Rotarex atherectomy device was used to perform mechanical thrombectomy within aortic kissing stents in the iliac bilaterally. The thrombus was successfully aspirated with the mechanical thrombectomy. Atherectomy was also performed using the Rotarex device in the Right Common Femoral artery stent to treat the 70% in stent restenosis. Three passes performed using the device.
This was followed by 6mm x 200mm simultaneous balloon angioplasty spanning the aorta just cephalad to the stent origin all the way through the right CFA.
Atherectomy was also performed using the Rotarex device in the Left Common Femoral artery stent to treat the 75% in stent restenosis. Three passes performed using the device. This was followed by 6mm x 200mm simultaneous balloon angioplasty spanning aorta just cephalad to the stent origin all the way through the Left CFA.
Balloon angioplasty with extended inflation 6mm was performed to the right Common Femoral Artery for dissection.
Post intervention - there is dramatically improved in flow, no residual flow limiting stenosis.
Catheter injection in suprarenal aorta fills bilateral iliacs/CFA/SFA. There is no sign of outflow obstruction.
IA nitro administered, sheaths carefully removed, pressure held.
IMPRESSION:
1. Extensive in flow disease treated with combination of thrombectomy, atherectomy, angioplasty as above. No residual in flow stenosis.
2. Right CFA dissection treated with extended 6mm angioplasty/inflation. No flow limitation.