Forum - Questions & Answers

Jan 15th, 2015 - curiouscoder 1 

Coding confusion

Hello, does anyone know and can please help clarify for me, which specific CPT® codes should be reported based on the following notes?

INDICATION:
1. Intermittent claudication with positive ABIs with mild
amount of exertion.
2. Peripheral arterial disease.

DESCRIPTION: After informed consent was obtained, the patient
was brought to the endoscopy suite and prepped according to
usual precaution. The patient was sedate with Versed and
fentanyl and left groin was prepped with 1% lidocaine. Access
was obtained in the left common femoral artery using modified
Seldinger method and 5 French Terumo sheath was placed. Through
the sheath, 0.035 Storq wire was passed and brought into the
distal aorta. A 5 French Omni Flush catheter was put on the
0.035 Storq wire and brought in the distal aorta. A distal
aortogram was performed. After performing the distal aortogram,
bilateral runoffs were performed with a setting of 10 x 100.

FINDINGS OF DIAGNOSTIC PORTION: The patient had three vessel
runoff bilaterally. The patient has 90% right common iliac
stenosis. The patient had 100% long stenosis of the right
superficial femoral artery. The patient had moderate diffuse
disease of the left iliac and left common femoral artery and
left superficial femoral artery.

DESCRIPTION OF INTERVENTION: At this point, 0.035 angled
Glidewire was used to move in the contralateral groin and 7
French 45 cm Terumo Destination sheath was placed in up and over
fashion to the contralateral side and brought in the distal
superficial femoral artery. Therefore, the final passes were
placed in the contralateral common femoral artery. At this
point, two wires were used to cross the superficial femoral
artery using a transition catheter as support. Initially the
straight guidewire was used to cross the lesion. After that it
was switched over for angled Glidewire and that was used to
successfully cross the lesion. The initial expansion was done
by 6 x 300 Admiral PTA balloon catheter. It showed suboptimal
results. Subsequently there was placement of 7 x 200 and 7 x
150 EV2 EverFlex stent which was post dilated with 6 x 300 PTCA
balloon as well as 7 x 40 Bard balloon with good angiographic
results. At that this point, it was decided to intervene on the
right common iliac artery which was initially dilated with
suboptimal result and finally stented with 8 x 51 EV3 self
expanding stent with good angiographic results.

PROCEDURES DONE:
1. Abdominal aortogram, *------* aortogram. Bilateral runoffs,
supervision intervention of bilateral lower extremities,
crossing over through the contralateral common femoral artery in
normal fashion. Position of distal catheter of the sheath was
in the contralateral common femoral artery. The distal most
extent of catheter was at the contralateral superficial femoral
artery.
2. Balloon dilatation of the *------* (INCOMPLETE).



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