Peripheral angiography... Help please!!!

Hello, I am new in coding peripheral angiography and I am really having quite ha a challenging time in coding this case. Can someone help me please. I also need to ask for techniques or ways to understand coding peripheral angiography better.
Thank you very much in advance.

I am not certain if I coded this case correctly...36246,37229,75716-26,36245,75710-26 (?????)

Reason for Evaluation: Severe claudication and peripheral arterial disease.

History of the Present Illness: This patient is well known to me for severe peripheral arterial disease with critical limb ischemia previously. She now has had an increasing ulcer and duskiness to her right foot. She has severe in stent restenosis. She continues to smoke. We have educated her at length regarding such, but her symptoms are rest claudication and a non healing ulcer. Thus, we have explained the risks, benefits, and alternatives of peripheral angiography plus/minus angioplasty,atherectomy, and stenting, and the patient agrees to proceed.

Procedure: The patient was brought to the catheterization lab and prepped and draped in a sterile fashion. Lidociane was placed to the left common femoral area. Using a micropunture technique, a 6 French-sheath was placed to the left common femoral artery. Angiography through the sheath down the left leg was performed. Next, up and over access was obtained with a Glidewire and a 6 French LIMA catheter. The LIMA catheter was placed to the level of the right common femoral artery. Angiography down the right leg was performed.

At this point a Glidewire was replaced. The LIMA catheter was removed and exchanged. The sheath was exchanged for a 6 French Ansel Sheath. Heparin was given for 2600 units. At this point a Regalia wire was placed into the distal potion of the anterior tibial artery. A glide catheter was placed to the level of the popliteal space. Wire was removed. Repeat angiography was performed. Through the glide catheter, the Regalia wire was replaced. A 2.0 balloon was placed into the distal portion of the anterior tibial artery. The regalia wire was removed and exchanged for a viper wire. The balloon was then removed as well. Over the viper wire, we did a 1.25 bur stealth atherectomy device on the entire SFA as well as the popliteal space. The atherectomy catheter would not get to the level of the anterior tibial artery. Thus, the atherectomy device was removed, and the balloon, a 2 X 40 Armada was placed to the distal anterior tibial vessel. Dilation was performed over the entire length of the anterior tibial artery. Repeat angiography was performed.

At this point balloon was removed, and the atherectomy with a 1.5 bur at both 60 and 90 speeds was performed over the entire portion of the right SFA. Bur was removed. Angiography was performed. Then post dilation was performed with a 4.0 X 80 Armada balloon over the entire length of the popliteal and SFA vessel.

At this point balloon was placed into the anterior tibial vessel. Then 300 mcg of nitroglycerin was given to the anterior tibial artery. Then it was brought back to the popliteal space with 300 mcg into the popliteal space. At this point wire was replaced. The balloon was removed. Repeat angiography down the entire length of the vessel was performed.

At this point wire and catheter were removed. The Sheath was placed to the level of the right common iliac vessel. Angiography of the iliac vessels was performed. It should also be noted that there was no gradient across both iliac vessels. The sheath was then brought back to the left external iliac and then removed, and manual pressure was held to the left common femoral artery with good groin hemostasis and no evidence of oozing, bruising or hematoma.

The patient tolerated the procedure well and remained hemodynamically stable.

Impression: On the left side, the left common iliac and external iliac are widely patent. The common femoral artery is also patent. The proximal portion of the SFA is patent. However, there is long stenting, and over its entire length there is severe diffuse greater than 80% in stent restenosis of these vessels. In the popliteal it is patent. The anterior tibial has severe diffuse disease over its entire length. The peroneal is patent. The posterior tibial vessel appears to be occluded.

On the right, the common and external iliac and common femoral arteries are widely patent. The profunda is patent. Right at the ostial portion of the SFA there is severe diffuse disease greater than 80%. In the mid segment of the SFA there is diffuse long stenting of the previous SFA, which is diffuse severe in-stent restenosis. In the popliteal space there is also greater than 80% severe disease. Status post atherectomy and then balloon angioplasty with a 4 X 80 Armada reveals significant improvement in flow and less than 30 % residual stenosis. In the infrapopliteal space, the anterior tibial had diffuse greater than 90% disease and at some point it was subtotal. Status post ballon angioplasty reveals less than 40% disease at the anterior tibial artery. The peroneal branch is patent, and the posterior tibial is occluded.

Post procedure: The patient tolerated the procedure well and remained hemodynamically stable. There was significantly improved flow via the anterior tibial and peroneal into the level of the foot, with branching vessels, visualized of the foot. The patient otherwise tolerated the procedure well. There was good groin hemostatis. We will follow with manual therapy and close follow on medical therapy. She has been on aspirin and plavix. We have again educated her on cigarette smoking cessation.