New to doing Carotid coding. Need help on codes please. Our physician did:
Left upper extremity angiography
Left common carotid angiography
Left subclavian artery PTA and stent
The patient was brought to the cardiac catheterization lab where he was prepped and draped in the usual sterile fashion. Using ultrasound guidance a 5 French micropuncture introducer set was used to obtain access into the right common femoral artery using a modified Seldinger technique in the usual manner without incident. This was exchanged out for a standard 6 French short sheath. Right iliofemoral angiography was then performed. An 035 inch versacore guidewire was used to advance a 90cm shuttle sheath to the descending aorta. A 6 French JR 4 catheter was used to engage the left common carotid and angiography was performed. Then the JR 4 catheter was used to perform angiography of the left subclavian artery. Attempt with an 0.018" wire was tried but unable to cross the stenosis. 2% lidocaine was used to infiltrate the left wrist region for local anesthesia. A 6 French slender sheath was inserted into the right radial artery using modified Seldinger technique in the usual manner but several attempts were performed until ultrasound guided access was successful. A 6 French JR 4 catheter was used with a 0.035" glide advantage wire to cross the left subclavian stenosis. The JR 4 was removed and then a 4.0×40 OTW balloon was inflated multiple times across the subclavian stenosis. The balloon was removed and a 6.0x29mm Omnilink was placed and deployed at 14 atm. The glidewire was removed and final images obtained. The catheters and sheaths were removed without incident. A Perclose device was used to place hemostasis of the right common femoral arteriotomy and remove the 6 French sheath. A TR band was placed over the left radial arteriotomy after several attempts to gain hemostasis. There was noted left forearm hematoma that was not expanding. Patient tolerated the procedure well and was transferred to PACU in a stable condition. Procedural findings:
Left subclavian artery: Severe 99% calcified stenosis
Left common carotid artery: Mild diffuse disease without critical stenosis.
Left internal carotid artery: 20-30% ostial stenosis.
Left external carotid artery: 10-20% ostial stenosis
without critical disease.
Left vertebral: retrograde filling pre procedure and antegrade filling post procedure.
Impressions:
1. Type II aortic arch with severe diffuse calcification.
2. Severe left subclavian artery stenosis
3. Successful PTA and stenting of left subclavian artery
4. Hemostasis of the right CFA using a Perclose
5. Hemostasis of the left radial artery using a TR band