Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

coding the following note

Debbie Posted Wed 30th of January, 2013 02:18:08 AM

PREOPERATIVE DIAGNOSIS:
1. Bilateral lower extremity ischemia with critical bilateral iliac stenoses and left superficial femoral/popliteal stenosis.
POSTOPERATIVE DIAGNOSIS:
1. Bilateral lower extremity ischemia with critical bilateral iliac stenoses and left superficial femoral/popliteal stenosis.
PROCEDURE PERFORMED:
1. Abdominal aortogram with bifemoral runoff via right groin percutaneous cannulation.
2. Aortic crossover cannulation fifth level left popliteal cannulation.
3. Left popliteal balloon angioplasty.
4. Left femoral retrograde cannulation.
5. Bilateral right common iliac angioplasty and stenting with kissing balloon technique.
6. Distal right common iliac angioplasty.
7. Right external iliac angioplasty.
ANESTHESIA: Local plus intravenous sedation.
INDICATIONS: The patient is a 74-year-old male with severe bilateral lower extremity arterial insufficiency with inflow iliac occlusive disease bilaterally as well as high-grade left superficial femoral/popliteal artery stenosis. He has severe claudication pain and subsequent leg weakness and paresthesias. He is considering lumbar back surgery and needs revascularization not only for severe symptomatic disease, but also with marked improvement he may not require back surgery. He understands the procedure and risks, including but not limited to, bleeding, infection, arterial disruption, distal embolization with ischemia, recurrent stenosis, myocardial infarction, stroke, death, renal insufficiency with dye injection and respiratory insufficiency with sedation. He appears to be a good candidate for conscious sedation and understands.
DETAILS OF PROCEDURE: The patient was brought to the special suite on 05/14/08 where he was placed in the supine position. After prepping and draping sterilely and infiltration with local Xylocaine, an 18-gauge arterial introducer needle inserted into the right common femoral through which a soft-tipped guidewire was inserted and over this a 6 French dilator and sheath were then subsequently passed. The right common iliac artery was extremely tortuous and stenotic, but with manipulation, the guidewire was subsequently advanced into the infrarenal aorta over which a pigtail catheter was inserted up to the level of LI. Abdominal aortogram with bifemoral runoff was then subsequently performed. This revealed a high-grade right renal artery stenosis. There was found to be bilateral high-grade/critical common iliac stenoses at their origin, as well as poststenotic dilatation. There was found to be a high-grade stenosis of the distal right common iliac artery and with later arteriograms, a right external iliac stenosis was uncovered. Distally, the common femoral, superficial femoral and popliteal and tibial vessels were patent, although there was found to be a critical stenosis of the proximal left popliteal corresponding to the lesion seen on magnetic resonance angiography, as well as a more moderate stenosis just distal to that. The pigtail catheter was exchanged for a contra catheter, which then allowed passage of a glidewire up and over the aortic bifurcation into the left superficial femoral artery. The contra was then exchanged for a 4 French glide catheter, which was then advanced into the superficial femoral artery and with wire and catheter techniques, the glidewire was advanced all the way across the popliteal lesion into the distal popliteal artery below the knee staying above the tibials. With advancing the glide catheter, the wire was exchanged for a Rosen wire. Repeat contrast injection confirmed the location of the proximal and mid-popliteal lesions and a 5 X 4 angioplasty balloon was then subsequently advanced across these lesions and inflated. Repeat contrast injection revealed marked improvement with good outflow. There was still some mild to moderate stenosis, but this was felt to be not hemodynamically significant and a good result. The guidewire and catheter were then retracted back with the catheter retracted back to the right common iliac artery. Guidewire advanced up into the infrarenal aorta and a percutaneous cannulation then made of the left common femoral artery where a 6 French dilator and sheath were passed and ultimately exchanged for a 7 French sheath. The long-angled sheath on the right side was exchanged for a shorter 7 sheath and this allowed bilateral femoral cannulation to approach the common iliac lesions. Repeat contrast injection confirmed the location and a 10 mm x 25 mm Expressed premounted Nitinol stent then advanced bilaterally up to the common iliac origins and with kissing balloon techniques, these were subsequently placed. Repeat contrast injection revealed excellent placement and position. An 8 mm angioplasty balloon then used to dilate the mid right common iliac artery and a 6 mm angioplasty balloon then used to dilate the distal right common iliac artery at the bifurcation, as well as a right external iliac stenosis that was found. Repeat contrast injection revealed marked improvement with good outflow. There was still some mild stenosis at the distal right common iliac bifurcation, but did not appear hemodynamically significant and felt best not to risk any disruption. In addition, there was chronic plaque irregularity of the mid-right common iliac artery, which was mildly dilated secondary to post-stenotic dilatation and it was felt best not to apply stents across all of these lesions, which might not give as good a result. Again, runoff looked good. The sheaths were then subsequently removed and star close system then used to control the cannulation sites. He tolerated his procedure well. He was found to have easily palpable dorsalis pedis pulses bilaterally postprocedure with markedly improved femoral pulses.

I was using 37221, 37220 - 59, 37222, 37224-51, 75630

SuperCoder Answered Wed 30th of January, 2013 18:11:09 PM

Please contact customer service for this. Thanks

Related Topics