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  1. User id : 23530 Posted 2 years ago

    * Final Report *

    Cardiac Cath (Verified)

    PERIPHERAL ANGIOGRAM AND PERIPHERAL INTERVENTION

    DATE OF PROCEDURE: 05/24/2011
    REFERRING PHYSICIAN:

    PROCEDURES PERFORMED
    1. Selective peripheral angiogram of the left lower extremity with catheter placed in the left common femoral artery.
    2. Selective angiogram of the iliac system with catheter placement in the ostium of the left common iliac artery.
    3. Peripheral angiogram of both iliac systems with pigtail catheter placement in the aorta above the bifurcation.
    4. Successful percutaneous transluminal angioplasty of the 80% in stent restenosis in the left common iliac artery stent with kissing balloon, percutaneous transluminal angioplasty of both iliac stents by bilateral access with retrograde approach.

    INDICATIONS
    1. Peripheral vascular disease with claudication.
    2. Coronary artery disease.
    3. Diabetes mellitus.
    4. Hypertension.
    5. Hyperlipidemia.

    HISTORY
    This is a 57-year-old white male with multiple medical problems including hypertension,hyperlipidemia, coronary artery disease status post stent, peripheral vascular disease with bilateral common iliac stents in the past, complaints of worsening claudication
    for the last six weeks, especially worsening in the left lower extremity. The patient gets claudication symptoms with walking 10 feet, which is limiting his exercise capacity. The patient was brought for peripheral angiogram and possible peripheral intervention.

    PROCEDURE DETAILS
    The patient was explained the risks, benefits, including alternatives to peripheral angiogram, as well as possible coronary intervention. The patient agree and consented for the procedures. Both procedures were performed under standard sterile technique.
    A 6 French sheath was introduced into the right common femoral artery under local anesthesia using Seldinger technique.

    PERIPHERAL ANGIOGRAM DETAILS
    I used a 6 French left internal mammary artery catheter as well as a 5 French glide catheter to do the left lower extremity peripheral angiogram. This was selective peripheral angiogram. Initially I placed the wire over the bifurcation into the left superficial femoral artery which was the superficial femoral artery, and then over the wire I got the glide catheter into the left superficial femoral artery and took the
    glide catheter into the left common femoral artery and repeated the angiogram. Then, I moved the glide catheter into the left common iliac ostium and repeated the angiogram of the iliac system, as well as the common femoral artery.

    The details of the left lower extremity angiogram are as follows
    1. The left common iliac artery stent has 80% end stent restenosis in the ostium with a gradient of about 20 mmHg across the lesion. The left external iliac artery shows mild disease. The left internal iliac artery shows moderate disease in the ostium. The left common femoral artery has mild disease. The left superficial femoral artery has mild disease. The left profunda femoris artery has mild disease. The left popliteal
    artery has mild disease. The left anterior tibial artery has mild disease. The left tibioperoneal trunk has mild disease. The left posterior tibial artery, and left peroneal artery also has mild disease. There is three vessel runoff to the left foot.
    2. The right common iliac artery stent is widely patent without any in stent restenosis. The right external iliac artery has mild disease. the right internal iliac artery has mild disease. The right common femoral artery has mild disease. Intervention of the left common iliac artery in stent restenosis is about 80%. The details are as follows:
    The left common iliac artery stent stenosis is in stent restenosis. The stenosis about 80%. I used a 6 French sheath Pinnacle 25 cm length sheath into the right common femoral artery. The right common femoral artery has a 6 French sheath already present. The left common
    femoral artery has the 6 French Pinnacle 25 cm bright tip sheath. Then, I used a 6 x 2 Perflex peripheral balloon into the right common iliac stent, and a 7 x 3 peripheral balloon into the left common iliac artery stent, and did a kissing balloon percutaneous transluminal angioplasty. The right balloon, which his 6 x 2, is inflated up to 4 atmospheres of pressure. The left peripheral balloon, which his 7 x 3, is inflated up
    to 7 atmospheres of pressure. Then, I did another kissing balloon with the same size on the right side with an 8 x 3 peripheral balloon on the left side. The 8 x 3 peripheral balloon on the left side is inflated up to 8 atmospheres of pressure. At the end of the procedure, the stent is well expanded on the left side. The stenosis had become less than 30%. The gradient across the lesion is abated. There are good distal pulses in the left foot, so I called this a successful percutaneous transluminal
    angioplasty of the 80% lesion in the left common iliac artery stent with kissing balloon percutaneous transluminal angioplasty due to presence of two stents in both common iliac arteries as a kissing stent.

    ADJUNCTIVE PHARMOTHERAPY
    1. Angiomax bolus and drip as per weight based protocol and creatinine clearance protocol.
    2. Aspirin preprocedure.
    3. Plavix preprocedure, and loading of 150 milligrams post procedure.

    CONCLUSION
    1. Successful percutaneous transluminal angioplasty of the 80% in stent restenosis in the left common iliac artery stent with kissing balloon percutaneous transluminal angioplasty to kissing stent in the iliac arteries.
    2. The rest of the left lower extremity arteries appear patent with mild disease.

    RECOMMENDATIONS
    1. Aspirin 325 milligrams daily times one month, then 81 milligrams daily lifelong.
    2. Plavix 75 milligrams daily times three years, as patient already has got stents.
    3. Surveillance ultrasound of the left iliac system.

    Note: Per my knowledge I did the Procedure coding for this Medical Record as 75710 & 37221 (Modifier 26) for professional component.

    & Diagnosis codes are 443.9, 414.01, 401.1, 272.4

    Please validate my Procedure & Diagnosis coding and let me know for any corrections.

    Thank you very much for your help.

    Oscar
    NAHVC

  2. SuperCoder Posted 2 years ago

    As per documentation of report, it seems there has been bilateral angioplasty(though the sentence starts with unilateral angioplasty) as well as bilateral angiography going by the interpretation (the details documented of both sides of iliacs).

    So, we can code 37221,37222 and 75716

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