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Jan 16th, 2015 - curiouscoder 1 

Cardiology Coding

What would be the correct codes for the following:

PROCEDURES: 1. Lower abdominal angiogram with bilateral iliac angiogram interpretation and performance. Unilateral lower extremity FSA angiogram interpretation. Unilateral right lower extremity angiogram interpretation. 2. Up and over crossing to the contralateral iliac artery with a catheter. 3. Distal catheter placement in the contralateral right sided superficial artery through spirography replacement. BPA angioplasty of superficial femoral artery contralateral region atherectomy of the contralateral right superficial femoral artery. DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was brought to the endoscopy suite and prepped according to precautions. Indications for the procedure was peripheral arterial disease with severe claudication, even with mild amount of regression. Access was obtained with a modified single method in the left common femoral artery. After access was obtained, a .035 super core wire was placed in the distal aorta. On the wire, a 5 French Omniflush catheter was placed and placed in the distal aorta, and the initial angiogram was performed. After the region was identified in the right common femoral artery which extended somewhat into the superficial external femoral artery which was 99% stenosed, it was decided to intervene. The patient's intervention site was patent. The 5 French Omniflush catheter was used to go across the contralateral in the up and over fashion and the distal wire was parked in the contralateral common femoral artery. Over that wire which initially was a 0.35 glidewire, that was exchanged for a wire. A 7 French balloon sheath was placed and brought in the contralateral common femoral artery using 0.14, this provided was used to cross the region. After that, a spider fixer was placed distal to the region. Because the plan was to debulk the atherectomy region. LSMs atherectomy device was used but after initial attempt, we were unable to cross the region, so that was withdrawn and at that point a 4 by 40 Autocross lead AV3 balloon was used to cross the region and dilated. With suboptimal results, at that point it was decided to proceed with directional atherectomy and the patient got approximately 8 cuts with suboptimal results. At that point, it was decided to dilate the region with the 6 by 40 EV3 Tower-Cross balloon and that balloon was dilated for 2 minutes with good angiographic results. The final picture showed good brisk flow, residual 10 to 20% region. Distal angiograph revealed no perforation or distal embolization and three vessel runoff. Final course of residual Dopplers initially became plus 2 after the procedure was done.



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