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Stenting the distal aorta

James Posted Thu 04th of September, 2014 14:41:04 PM

Please help,the doctor is telling me there is a code out there, I can't find it.
The distal aorta was stented, I can not find a cpt code for stenting the distal aorta or would you use 37223 Iliac stent additional vessal? I've listed the entire op note. Thank you.

Description of Procedure:. After the patient was appropriately consented and all the risks and benefits of the procedure are explained to the patient, the patient groins are prepped and draped in the standard surgical fashion. The left groin is accessed under ultrasound guidance and 1% lidocaine plain is injected into the skin and subcutaneous tissues in the amount of 20 ml. Under ultrasound guidance the left CFA is accessed with an 18 gauge needle. Then using a 0.035 access wire through the needle the wire was introduced into the aorta followed by placement of a 5 fr sheath after removal of the needle. The sheath was flushed with heparinized saline solution. 2000 units of heparin are administered IV. At that point a 5 fr VCF catheter was placed into the Aorta to the level of L3 and an Aortogram was performed. The patient was given an additional 5000 units of heparin IV.

Findings: Diffuse aortic disease with mild ectasia, Iliac stents are widely patent bilaterally. The distal aorta and proximal iliac arteries seem to be stenotic about 60-70% bilaterally and the distal aorta seemed to be about 60-70%.

In a 3rd order selection the right external iliac artery is accessed and selective angiography was performed of the right lower extremity.
Findings: Total distal stent occlusion with reconstitution of the distal SFA and proximal Pop through geniculate collaterals. Single vessel runoff down the right anterior tibial artery.
Occlusion of the TPT, Peroneal, and Posterior Tibial artery.

At that point the VCF catheter was introduced into the SFA after careful navigation with in the stent and then using a 5 fr Slip Cath the occlusion was breeched and the wire was placed distally into the AT. Then the catheter was placed distally into the AT in a 3rd order plus selection and a study was shot.

Findings: Patent flow down a diseased anterior tibial artery. The proximal AT has diffused stenosis ranging from 50% to 70%.

The wire was then placed distally into the AT. The occlusion of the SFA stent was then treated with a 2.3 Turbo Elite laser as following:

2 passes @ 45 fluence/ 25 pulse rate
2 passes @ 60/45
AT that point the area was shot and examined. The occlusion was resolved however their was residual stenosis within the stent and the proximal popliteal artery. Then the area was treated again with 2 passes @ 60/60.

Tota Laser Time of 6 min 51 sec, Total Pulses 15,841.

Then the area was rechecked and had some residual stenosis of about 20-30% and this was then treated with PTA using a 5 mm x 14 cm Cook Balloon at 12 ATM for 2 minutes. Upon completion of the PTA the area was studies again demonstrating excellent results. Then attention was focused on the AT, which was then treated with a 4.0 mm x 140 mm PTA at 6 ATM for 2 minutes.

Completion angiography demonstrated excellent results.

Attention was then directed at remodeling the distal aorta and proximal iliac arteries. The area was noted to have high grade stenosis, 60-70% in the distal aorta and 60-70% bilateral proximal common iliac arteries.

The right groin was then accessed and 1% lidocaine plain is injected into the skin and subcutaneous tissues in the amount of 20 ml. Under ultrasound guidance the right CFA is accessed with an 18 gauge needle. Then using a 0.035 angled access wire through the needle, the wire was introduced into the aorta followed by placement of a short 7 fr sheath after removal of the needle. The sheath was flushed with heparinized saline solution. At that point a 0.035 wire was placed into the Aorta. The left 7 french sheath was pulled back into the CIA. Anothe 0.035 wire was placed proximally into the Aorta. Then two 7 mm x 38 mm iCast stents were introduced into the distal Aorta and proximal common iliac artery. The stents were both deployed at 8 ATM simultaneously.

Completion angiography demonstrated good resuts with resolution of the distal aortic stenosis and proximal common iliac artery stenosis.

The sheaths were pulled over a wire individually and 6 french Anigioseals were deployed successfully.
Good hemostasis was obtained, Mupirocin ointment and sterile occlusive dressings were applied.
Complications: None.
Total Contrast: 65 ml of Visipaque.
Findings Summary: Right SFA occluded stent and 70 % stenosis of the proximal AT. Dista aortic stenosis 60-70% and proximal bilateral proximal CIA stenosis.

SuperCoder Answered Wed 10th of September, 2014 06:54:52 AM

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