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Angioplasty, Arteriogram and Bypass Graft

Nicole Posted Wed 05th of June, 2013 15:33:13 PM

Any help with the coding of the procedure below would be greatly appreciated!

The infusion cath was retracted back into the bypass graft at the proximal knee. A selective left anterior tibial arteriogram was then performed. After reviewing the images, it was evident that the patient had an anastomotic stenosis as well as diseased anterior tibial artery at the mid portion. The arteriogram was performed after nitroglycerin infusion to improve the vessels lumen size. At this time, a mailman guide wire was placed via the infusion cath into the anterior tibial artery down to the ankle. The infusion cat was then removed and a 1.5mm x 12cm angioplastic balloon was advanced into the anterior tibial artery and angioplasty performed. The balloon was then deflated and brought back to the arterial anastomosis and angioplasty performed again. A repeat arteriogram shows that the anterior tibial artery vessel size improved, but the anastomosis did not improve. At this time, a 2mm x 2cm angioplastic balloon was placed over the guide wire and angioplasty performed of the anastomosis which improved the stenosis on post angioplasty arteriogram. At this time, all cath's were removed. The sheath was left in place so that the sheath can be removed after the PTT returned to normal.

Thank You in Advance!

SuperCoder Answered Sun 09th of June, 2013 22:51:38 PM

Here are some codes to consider depending on the complete procedure, including access and termination points for the cath and the graft connections:
* Check complete documentation to see if a code from 37211-37214 applies (and if so, if follow-up tibial imaging is covered under that code)
* 75710-26 - Angiography, extremity, unilateral, radiological supervision and interpretation (if appropriate)
* 37228 - Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel with transluminal angioplasty

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