Jami Posted Fri 05th of January, 2018 17:42:18 PM
I have a question regarding TPA and stenting . I would use these code:37227,37231,75625,75710,76937,37252,37253. Would this be correct?
Patient is here for Aortogram with runoff and possible endovascular intervention. The patient understands all the risks and benefits of the procedure and wishes to proceed. The patient is having this procedure for lifestyle limiting claudication of the right lower limb with arterial duplex evidence of increased velocity flows in the SFA and TPT. The patient has not had a prior aortogram or angiogram prior to his new complaint.
1. US guided left common femoral artery access.
2. Aortogram with runoff of the right lower extremity.
3. 3rd Order selection + of contralateral lower extremity.
4. IVUS of the right peroneal, TPT, popliteal, SFA, and CFA.
5. Phoenix 2.2 mm x 130 cm atherectomy of the SFA, pop, and TPT/proximal Pr.
6. PTA and stenting of SFA with 5 x 100 Supera Idev, PTA and stenting of TPT with 3.5 x 1.5 cm Xience Alpine.
7. 6 Fr Perclose of the left puncture site.
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's groins are prepped and draped in the standard surgical fashion. The left groin is accessed with ultrasound 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 5 fr sheath after removal of the needle. The sheath was flushed with heparinized saline solution. At that point a 5 fr NEFF catheter was placed into the Aorta in a 2nd order selection to the level of L1 and an Aortogram was performed.
Findings: Diffusely diseased distal aorta and iliac vessels without significant stenosis.
Then the NEFF over a 0.035 wire was placed up and over into the right external iliac artery. Then angiography of the right lower extremity was performed.
Findings: Patent right PFA, CFA, and proximal SFA.
Then in a 5 order selection the right SFA is accessed proximally and then angiography was performed from the NEFF catheter.
Fingings: Diffusely diseased mid SFA, high grade stenosis of the SFA, 90% angiographically. The popliteal is diffusely disease without significant stenosis.
Then the NEFF was taken down to the distal SFA and angiography was performed.
Findings: The AT is occluded totally. The TPT is diffusely diseased with stenosis about 60%. The PT is occluded. The TPT travels to the foot.
At that point the 0.035 wire was reintroduced into the distal SFA and the sheath was removed and a 6 fr 45 cm sheath was placed distally into the right EIA. It was flushed with HS and the patent was given 5000 units of heparin IV.
Then a 0.014 Phoenix wire was placed into the peroneal artery. An IVUS was used over the wire and taken down to the peroneal artery and then pulled and recorded.
Findings: The peroneal artery is normal caliber, with wall enhancement due to medial wall calcification. The TPT trunk has a isolated segmental stenosis of 71.1%, the popliteal artery is diffusely disease with stenosis less than 40%. The SFA at the adductor canal has a stenosis of 87.5% for about 2 cm segment.
Then the Phoenix 2.2 device was introduced and the distal SFA was treated with four passes, then the popliteal and the TPT was treated with four passes.
IVUS was reintroduced and demonstrates improvement of flow, but with residual stenosis. The TPT was stented above the origin of the peroneal artery with a 3.5 mm x 1.5 cm Xience Alpine Stent and deployed at 12 ATM. Then the SFA was treated with a 5 mm x 100 mm PTA balloon at 10 ATM for two minutes. Then IVUS was introduced and demonstrated an area of dissection that was then stented with a 5 mm x 100 mm IDEV supera stent at the adductor canal.
Completion IVUS demonstrated excellent results with excellent flow down the peroneal artery.
600 MCG of NTG was given selectively into the SFA.
The sheath was pulled over a wire. A 6 french Perclose was used to close the puncture site. Good hemostasis was obtained, Mupirocin ointment and sterile occlusive dressings were applied. US was used to access the common femoral artery flow. The flow is patent. Patient tolerated the procedure well and was sent to recovery in satisfactory condition.
SuperCoder Answered Mon 08th of January, 2018 06:57:33 AM
As per the given scenario above given codes seems appropriate. Please append modifier 59 with CPT code 75710 as per CCI.
hope this helps!