Monica Posted Tue 30th of October, 2012 00:24:17 AM
CPT's Dx's and modifiers please.
Post op dx: atherosclerotic cerebrovascular disease, transient ischemic attack, carotid stenosis.
Malignant hypertension with bilateral renal artery stenosis
I used a right coronary catheter and performed left and right carotid angiography. I then pulled back and performed left and right renal angiography, which was a planned procedure. This showed critical obstruction of both renal arteries with profound gradients both renal arteries. The left kidney had an ulcerative eccentric subtotal proximal stenosis. I crossed it with a 4 10,000 wire and a 4.5 balloon. I pre-dilated with this balloon. I then used a 7x19 stent and passed this across the lesion. I deployed the stent and had excellent opening of the obstruction. There was complete elimination of the gradient, which exceeded 170 mm pre-stent and was 0 mm post-stent. I then came back and measured the gradient across the right renal artery. Although we did not totally cross the obstruction completely, there was a marked gradient of about 60mm across the right renal stenosis. I then used a 7x29 stent across this lesion. I did feel like the stent was too long, but our supplies were limited and this is what was the best available stent. We deployed it and carefully positioned it across this artery. After deployment there was no residual obstruction and there was no resident gradient. I then withdrew the catheters. The patient will be receiving plavix because of carotid lesions and the new stents.
Findings: Right internal carotid eccentric ulcerative 40% stenosis without flow limitation. The left internal carotid has an ulcerative 30-50% proximal stenosis.
The left renal artery has an eccentric subtotal stenosis that has no residual obstruction upon stent deployment . The right renal artery has 75% stenosis with a long lesions eccentric proximally and there is no residual obstruction upon stent deployment and no residual gradient.
SuperCoder Answered Wed 31st of October, 2012 20:44:58 PM
Please contact customer service. We have a different category to submit OP reports called SuperCoding-On-Demand.It seems to be missing some info that would help with code selection, though - need to know where the catheters were placed and which vessels were viewed/interpreted.
Monica Posted Fri 02nd of November, 2012 02:29:17 AM
This is ridiculous!!!!!!!!!!!!!!!!! I've paid for a service which you do NOT provide. Not only that, you have provide INCORRECT answers to procedures per our auditors. Your service is incredibly POOR!!!!!!!!!!