maljdcpc
Networker
Need advice on vascular coding please--Am I coding this correctly? Not sure about the aortogram? Any help would be greatly appreciated!
PROCEDURE:
1. Ultrasound-guided access of the right common femoral artery.
2. Abdominal aortogram.
3. Left lower extremity runoff.
4. Angioplasty and atherectomy of the left popliteal artery.
5. Angioplasty and atherectomy of the left tibioperoneal artery.
6. Angioplasty of the left anterior tibial artery.
FINDINGS: The aorta appears to be patent. The left renal artery appears to
be widely patent. The right renal artery appears to have area of 60 percent
stenosis at its origin. Bilateral common iliac, external iliac, and
hypogastric arteries appear to be patent. On the left side, the common
femoral, profunda femoris, and SFA appears to be patent. Popliteal appears
to terminate just below the knee and the trifurcation and essentially is
occluded, otherwise, there appeared to be reconstitution of 3 vessels
towards the foot.
OPERATIVE DETAILS: After informed consent was obtained, the patient was
brought to the procedure room. He was then prepped and draped in sterile
fashion. One percent lidocaine was used to infiltrate the area of the
anticipated puncture site. Using the ultrasound, the common femoral artery
on the right was visualized. It appeared to be patent and an image of that
was saved in to the patients chart. It was then accessed in retrograde
fashion with an 18-gauge needle, a 0.035 guidewire and a 5-French sheath. An
Omniflush catheter was then positioned at the level of L1. A flush aortogram
was obtained. The catheter was then withdrawn to the iliac bifurcation.
Utilizing a Glidewire, the common femoral artery on the left was cannulated.
Runoff of the left lower extremity was performed. Decision was made to
intervene; therefore, a 7-French sheath was positioned in the proximal SFA.
Using a crossing catheter and a Glidewire, initially it was advanced into
the peroneal artery. Successful intraluminal reentry was confirmed by distal
subtraction angiography. At this point, the 1.6 mm Jetstream Pathway
catheter was used to perform atherectomy. Following this, the 3 mm balloon
was used to perform angioplasty of the distal popliteal, tibioperoneal
artery and proximal peroneal. Additionally, the 4 mm x 6 cm balloon was used
to perform angioplasty of the tibioperoneal artery and distal popliteal and
later the 4 mm x 6 cm Lutonix drug-coated balloon was used to perform
further angioplasty. At this point, an attempt was made to cannulate the
anterior tibial artery origin, which was successful. This was angioplastied
with a 3.5 mm x 6 cm balloon. At this point, repeat injection demonstrated
brisk flow into the anterior tibial; however, the tibioperoneal artery
appears to have occluded. An additional attempt was made to cannulate it;
however, unsuccessful with some slight results and dissection. Therefore,
the procedure was deemed complete. The sheath was withdrawn. Manual pressure
was held for approximately 15 minutes. There was no bleeding, no hematoma,
and the patient was taken to recovery room in stable condition with palpable
pedal pulses.
37225
37229
37232
75710-59-26
75625-26
76937-26
PROCEDURE:
1. Ultrasound-guided access of the right common femoral artery.
2. Abdominal aortogram.
3. Left lower extremity runoff.
4. Angioplasty and atherectomy of the left popliteal artery.
5. Angioplasty and atherectomy of the left tibioperoneal artery.
6. Angioplasty of the left anterior tibial artery.
FINDINGS: The aorta appears to be patent. The left renal artery appears to
be widely patent. The right renal artery appears to have area of 60 percent
stenosis at its origin. Bilateral common iliac, external iliac, and
hypogastric arteries appear to be patent. On the left side, the common
femoral, profunda femoris, and SFA appears to be patent. Popliteal appears
to terminate just below the knee and the trifurcation and essentially is
occluded, otherwise, there appeared to be reconstitution of 3 vessels
towards the foot.
OPERATIVE DETAILS: After informed consent was obtained, the patient was
brought to the procedure room. He was then prepped and draped in sterile
fashion. One percent lidocaine was used to infiltrate the area of the
anticipated puncture site. Using the ultrasound, the common femoral artery
on the right was visualized. It appeared to be patent and an image of that
was saved in to the patients chart. It was then accessed in retrograde
fashion with an 18-gauge needle, a 0.035 guidewire and a 5-French sheath. An
Omniflush catheter was then positioned at the level of L1. A flush aortogram
was obtained. The catheter was then withdrawn to the iliac bifurcation.
Utilizing a Glidewire, the common femoral artery on the left was cannulated.
Runoff of the left lower extremity was performed. Decision was made to
intervene; therefore, a 7-French sheath was positioned in the proximal SFA.
Using a crossing catheter and a Glidewire, initially it was advanced into
the peroneal artery. Successful intraluminal reentry was confirmed by distal
subtraction angiography. At this point, the 1.6 mm Jetstream Pathway
catheter was used to perform atherectomy. Following this, the 3 mm balloon
was used to perform angioplasty of the distal popliteal, tibioperoneal
artery and proximal peroneal. Additionally, the 4 mm x 6 cm balloon was used
to perform angioplasty of the tibioperoneal artery and distal popliteal and
later the 4 mm x 6 cm Lutonix drug-coated balloon was used to perform
further angioplasty. At this point, an attempt was made to cannulate the
anterior tibial artery origin, which was successful. This was angioplastied
with a 3.5 mm x 6 cm balloon. At this point, repeat injection demonstrated
brisk flow into the anterior tibial; however, the tibioperoneal artery
appears to have occluded. An additional attempt was made to cannulate it;
however, unsuccessful with some slight results and dissection. Therefore,
the procedure was deemed complete. The sheath was withdrawn. Manual pressure
was held for approximately 15 minutes. There was no bleeding, no hematoma,
and the patient was taken to recovery room in stable condition with palpable
pedal pulses.
37225
37229
37232
75710-59-26
75625-26
76937-26