MACACERES
Contributor
Hi everyone,
I can't seem to find any real information on when it is okay to bill for a 35226 - blood vessel repair. Here is an OP note example:
DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was brought into the operating room, placed on the table in the supine position. He was placed under general anesthesia, and an LMA was placed. He was given preoperative antibiotics and prepped and draped in the usual sterile fashion. A time out was performed. Using ultrasound, we identified the common femoral artery on the right side; 1% lidocaine was used to anesthetize the skin overlying the tissue and the artery. A thin-walled 18-gauge needle was introduced in a similar trajectory in a retrograde fashion. Once arterial bleeding was identified, a J-wire was advanced without difficulties followed by a 6-French sheath. An angled Glidewire and a Royal Flush catheter were then inserted into the iliac vessel proximally. The catheter was then reformed in the distal aorta and the contralateral iliac artery was engaged. The wire advanced, but the catheter would not. We then exchanged out for a slip catheter that advanced into the contralateral limb. An angiogram was performed, which showed no disease process in the iliac system. The common femoral artery was patent as well as the profunda femoris artery with some stenosis distally. However, the superficial femoral artery had an abrupt occlusion immediately distal to its origin. By maneuvering the image intensifier, we were able to isolate the origin of the superficial femoral artery. We then exchanged the catheter for a longer sheath over a Bentson wire. The 7-French Ansel 1 sheath was advanced near the origin of the superficial femoral artery. Using an angled Glidewire and MPA catheter, we were able to isolate the superficial femoral artery and have ultimately advanced the wire and the catheter distally. We exchanged the Shore angled Glidewire for a longer one through the MPA catheter. With maneuvering and gentle manipulation over a slip catheter, the wire ultimately advanced through the occlusion as well as through the occluded stent into the popliteal artery. A confirmation angiogram was performed, which showed no evidence of extravasation. A roadrunner 0.014 wire was advanced into the popliteal and posterior tibial segment. The patient received a full 6000 units of heparin by this time. We chose the 2.4 mm XC atherectomy catheter that was entered into the origin of the superficial femoral artery. Multiple passes were made to increase the luminal diameter. We had some difficulties in certain locations where the acceleration was diminished due to overlying disease. Once completely through the areas of occlusion, the entirety of the atherectomized site was gently balloon dilated using a 6 x 200 Dorado balloon. We did note some proximal stenosis at the origin as well as disease in the distal stent of the superficial and popliteal interface. We performed an angiogram distally that demonstrated the anterior tibial to be completely occluded. The peroneal also appeared to be occluded. There was focal areas of stenosis of the posterior tibial artery with reconstitution. We were able to manipulate the roadrunner wire down to the posterior tibial artery and balloon dilated the proximal segment using a 2 x 120 Ultraverse balloon. Upon completion, we noted increasing spasm and did not pursue this further. More proximally, we decided to use a 6 x 80 Dorado balloon at the proximal segment of the superficial femoral artery as well as the distal segment of the stent. Upon completion, the distal aspect of the SFA appeared widely patent proximally. There appeared to be a crescent type of stenosis. However, placing a stent was not a viable option, because of its proximity to the bifurcation. A completion angiogram of the leg demonstrated flow all the way down to the foot. Satisfied with our revascularization, we exchanged the long 7-French sheath for a short 7-French Pinnacle sheath over a Bentson wire. We injected the entry site with Marcaine. The sheath was then exchanged for a Perclose device, which was used to primarily repair the common femoral artery puncture site. Upon completion, we had adequate hemostasis. A dry sterile dressing was applied, followed by Op-Sites. The patient was then awoken and extubated and taken to recovery for further care. He tolerated this procedure well. Needle and sponge counts were correct.
and the provider wants to bill for:
35226
36247
37225
37232
75710
76937
I hope someone can help!
I can't seem to find any real information on when it is okay to bill for a 35226 - blood vessel repair. Here is an OP note example:
DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was brought into the operating room, placed on the table in the supine position. He was placed under general anesthesia, and an LMA was placed. He was given preoperative antibiotics and prepped and draped in the usual sterile fashion. A time out was performed. Using ultrasound, we identified the common femoral artery on the right side; 1% lidocaine was used to anesthetize the skin overlying the tissue and the artery. A thin-walled 18-gauge needle was introduced in a similar trajectory in a retrograde fashion. Once arterial bleeding was identified, a J-wire was advanced without difficulties followed by a 6-French sheath. An angled Glidewire and a Royal Flush catheter were then inserted into the iliac vessel proximally. The catheter was then reformed in the distal aorta and the contralateral iliac artery was engaged. The wire advanced, but the catheter would not. We then exchanged out for a slip catheter that advanced into the contralateral limb. An angiogram was performed, which showed no disease process in the iliac system. The common femoral artery was patent as well as the profunda femoris artery with some stenosis distally. However, the superficial femoral artery had an abrupt occlusion immediately distal to its origin. By maneuvering the image intensifier, we were able to isolate the origin of the superficial femoral artery. We then exchanged the catheter for a longer sheath over a Bentson wire. The 7-French Ansel 1 sheath was advanced near the origin of the superficial femoral artery. Using an angled Glidewire and MPA catheter, we were able to isolate the superficial femoral artery and have ultimately advanced the wire and the catheter distally. We exchanged the Shore angled Glidewire for a longer one through the MPA catheter. With maneuvering and gentle manipulation over a slip catheter, the wire ultimately advanced through the occlusion as well as through the occluded stent into the popliteal artery. A confirmation angiogram was performed, which showed no evidence of extravasation. A roadrunner 0.014 wire was advanced into the popliteal and posterior tibial segment. The patient received a full 6000 units of heparin by this time. We chose the 2.4 mm XC atherectomy catheter that was entered into the origin of the superficial femoral artery. Multiple passes were made to increase the luminal diameter. We had some difficulties in certain locations where the acceleration was diminished due to overlying disease. Once completely through the areas of occlusion, the entirety of the atherectomized site was gently balloon dilated using a 6 x 200 Dorado balloon. We did note some proximal stenosis at the origin as well as disease in the distal stent of the superficial and popliteal interface. We performed an angiogram distally that demonstrated the anterior tibial to be completely occluded. The peroneal also appeared to be occluded. There was focal areas of stenosis of the posterior tibial artery with reconstitution. We were able to manipulate the roadrunner wire down to the posterior tibial artery and balloon dilated the proximal segment using a 2 x 120 Ultraverse balloon. Upon completion, we noted increasing spasm and did not pursue this further. More proximally, we decided to use a 6 x 80 Dorado balloon at the proximal segment of the superficial femoral artery as well as the distal segment of the stent. Upon completion, the distal aspect of the SFA appeared widely patent proximally. There appeared to be a crescent type of stenosis. However, placing a stent was not a viable option, because of its proximity to the bifurcation. A completion angiogram of the leg demonstrated flow all the way down to the foot. Satisfied with our revascularization, we exchanged the long 7-French sheath for a short 7-French Pinnacle sheath over a Bentson wire. We injected the entry site with Marcaine. The sheath was then exchanged for a Perclose device, which was used to primarily repair the common femoral artery puncture site. Upon completion, we had adequate hemostasis. A dry sterile dressing was applied, followed by Op-Sites. The patient was then awoken and extubated and taken to recovery for further care. He tolerated this procedure well. Needle and sponge counts were correct.
and the provider wants to bill for:
35226
36247
37225
37232
75710
76937
I hope someone can help!