I just took over coding for this MD and have not done lower extremities very often. looking for some clarification on this procedure.
The MD only charged: 75625-26 & 75716-26,59
Shouldn’t he be able to also include cath placement? Or is this truly bundled?
I am getting conflicting information from lower extremity coders.
Any help with proper code selection for this case would be greatly appreciated.
Thank you,
PROCEDURES PERFORMED:
1. Abdominal aortogram.
2. Selective right common femoral artery angiogram and distal runoff.
3. Selective left common femoral artery angiogram of distal runoff.
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BRIEF HISTORY: This is a 74-year-old gentleman with longstanding history of
smoking recently presented to our clinic for evaluation of symptoms of severe
left lower extremity claudication and abnormal lower extremity arterial
Doppler flow study revealing ABIs in the severe claudication range of the left
lower extremity.
*
PROCEDURE DESCRIPTION: A 6-French sheath was placed in the right common
femoral artery. Abdominal aortogram was performed by placing a 6-French
pigtail catheter in the distal abdominal aorta with subsequent power injection
of contrast. Selective right common femoral artery angiogram and distal
runoff is performed via power injection of contrast through the right common
femoral arterial sheath. Then, we proceeded to advance a 5-French LIMA
diagnostic catheter into the proximal segment of the left common femoral
artery. Left common femoral artery angiogram and distal runoff was performed
via power injection of contrast through the LIMA diagnostic catheter. The
LIMA diagnostic catheter was subsequently advanced into the midsegment of the
left superficial femoral artery. Subsequent injection of contrast was
performed through the LIMA diagnostic catheter to visualize the left
infrapopliteal vessels. No complications were noted.
*
TECHNICAL FACTORS: Omnipaque 140 mL.
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ABDOMINAL AORTOGRAM: There is presence of infrarenal abdominal aortic
aneurysm. Bilateral common iliac arteries appear to be aneurysmal. The right
common iliac artery reveals no significant luminal stenosis. Left common
iliac artery reveals severe 97% ostial calcific stenosis. Right external
iliac artery appears to be widely patent. Left external iliac artery is
widely patent. Right internal iliac arteries are widely patent with mild
proximal and mid stenosis. Left internal iliac artery reveals moderate 70%
proximal stenosis.
*
RIGHT COMMON FEMORAL ARTERY ANGIOGRAM AND DISTAL RUNOFF: Right common femoral
artery reveals no significant luminal stenosis. Right profundus femoral
artery reveals severe 80% proximal stenosis. Right superficial femoral artery
reveals severe 75% to 80% proximal stenosis and severe diffuse 70-90% mid
stenosis. Distal segment of the right superficial femoral artery reveals mild
luminal stenosis. Right popliteal artery reveals diffuse severe 70-75% mid
stenosis. Right anterior tibial artery is widely patent. Right peroneal
artery is widely patent. Right posterior tibial artery is widely patent.
*
LEFT COMMON FEMORAL ARTERY ANGIOGRAM AND DISTAL RUNOFF: Left common femoral
artery reveals mild 40% distal stenosis. Left profundus femoral artery is
widely patent. Left superficial femoral artery appears to be patent with
diffuse moderate 50% to 60% mid to distal stenosis. Left popliteal artery
appears to be chronically occluded proximally with reconstitution distally via
collaterals. Left anterior tibial artery, left posterior tibial artery and
left peroneal artery are widely patent. These vessels appear to reconstitute
proximally and appeared to be patent all the way down to the foot.
*
SUMMARY:
1. Right lower extremity angiogram and distal runoff reveals severe proximal
80% right profundus femoral artery stenosis, severe 70% to 90% proximal to mid
diffuse right SFA stenosis, severe 70% to 75% mid right popliteal artery
stenosis and a widely patent 3-vessel right infrapopliteal runoff consisting
of patent right posterior tibial artery, patent right peroneal artery and
patent right anterior tibial artery.
2. Severe 97% left common iliac artery ostial calcific stenosis, chronic left
proximal popliteal artery occlusion with reconstitution distally with a
3-vessel left infrapopliteal runoff.
3. Bilateral common iliac artery appeared to be aneurysmal.
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PLAN: We will ask for vascular surgery consultation for potential surgical
revascularization of the left lower extremity. Pletal 100 mg p.o. b.i.d. will
be started today for symptomatic relief. Emphasize aggressive risk factor
modification including the importance of smoking cessation.