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I have codes 75630 and 36200. Does anyone know if I am missing another code and modifiers? I do not code these procedures.
Thanks
PREOPERATIVE DIAGNOSIS:
Abdominal wall abscess.
POSTOPERATIVE DIAGNOSIS:
Abdominal wall abscess involving urethral sling.
PROCEDURE PERFORMED:
Exploration of abdominal wall with debridement and drainage.
DESCRIPTION OF PROCEDURE:
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The abscess was slightly to the right of midline extending from across the symphysis towards the right mons and labia. The incision was made to the right of midline, carried down through subcutaneous tissue. Upon entering the cavity, foul-smelling frothy fluid exuded. Cultures for anaerobic and anaerobic were taken. There was necrotic tissue underneath. Extensive debridement was performed tunneling to the left of midline along the pubic ramus was noted and then significantly towards the labia and then also towards the right anterior superior iliac spine. The area was well debrided completely open with no residual necrotic tissue appreciated. In the base of the wound, the sling was noted. The thinned end of polypropylene was easily detached on the left side, but as well secured to the right of midline and tunneling down towards the introitus in the urethra. It was still well attached. Decision was not to more aggressively pull on this but to tag it with 0 silk suture and __________ that proper debridement of all areas were performed. The debridement extended from the skin through all subcutaneous tissue down to the pubic ramus and symphysis. The fascia was exposed. The area of debridement measured approximately 15 cm x 12 cm. The
patient’s wound was packed with Kerlix and a dry sterile dressing. She was taken to recovery room in stable condition.
We’re working on the below procedure and need some input on coding…. any help will do…….(Hi Jim,… Happy 4th of July 2018!!!)……
PROCEDURES PERFORMED:
Bilateral Renal.Angiogram Aortagrarn-Abdominal Aortagram- Root/Acending Left Subcfavian Angiography
Unilateral Extremity Angio Right Bilateral extracraniaf carotid angiogram
INDICATIONS:
173.9 170. 213
FINDINGS:
Abdominal aortogram:
Normal size severely calcified abdominal aorta.
There is a large calcified plague at the level of the left renal artery. extending to the mid abdominal aorta, which creates about 60 percent stenosis of the descending aorta.
There is 20 millimeter gradient between thoracic descending aorta. and distal abdominal aorta. Distal abdominal aorta is ectatic with moderate calcified plague, but without aneurysm, dissection of obstructive disease.
Bilateral selective renal angiogram:
Right main renal artery is a medium-sized vessel without evidence of any obstructive disease
Right kidney appears reduced in size.
Left main renal artery is a small diffusely diseased vessel with 99 percent proximal stenosis
Left kidney is severely reduced in size, atrophic.
Bilateral iliac anqiogram:
Left common iliac artery is the large vessel, with patent stent in the proximal -mid portion, which appears a little undersized for the size of the artery, but nevertheless is wide open.
Left hypogastric artery is patent.
Left external iliac artery is a medium-sized vessel, there is about 40 percent proximal portion proximal portion stenosis immediately after bifurcation with hypogastric. appears nonobstructive.
Left common femoral artery is medium size mildly calcified patent vessel with about 30 percent stenosis, proximal left deep femoral, and superficial femoral arteries are patent.
Right common iliac artery is a large vessel, with about 10 percent ostial stenosis, nonobstructive. Right hypogastric artery is a large vessel. there is 80 percent ostial stenosis. there is 80 percent midportion stenosis, hypogastric artery supplies collaterals to the right deep femoral artery, and in turn to the superficial femoral artery.
Right external iliac artery is occluded entirely.
Right common femoral artery is severely calcified and is chronically occluded with only bifurcation to right deep, and right superficial femoral artery patent.
Aortic arch angiogram, and selective bilateral extracranial carotid angiogram, and selective left subclavian angiogram:
Normal size type 2 aortic arch with moderate calcification of the lesser and greater curvature without obstructive or mobile plague, no aneurysm or dissection.
lnnominate artery is a large calcified vessel, with not more than 20 percent nonobstructive stenosis. It gives rise to the large right subclavian artery. which has no evidence of obstructive disease, and gives medium-size right vertebral artery with antegrade flow.
Right carotid artery is the large vessel. distal common carotid artery has calcific 50 percent stenosis, transitioning into the 70 percent calcific stenosis of the proximal internal carotid artery; mid-distal internal carotid artery is free of significant stenosis.
Right external carotid artery is chronically occluded.
Left carotid artery is a large calcified vessel with 90-95 percent ostial common carotid stenosis, the rest of the common carotid artery is free of significant disease, there is 50 percent calcific stenosis of the proximal internal carotid artery: mid-distal internal carotid arteries free of significant stenosis.
Left external carotid artery is chronically occluded.
Left subclavian is a large vessel with 20-30 percent ostlal stenosls, nonobstructive, gives rise to large left vertebral artery with antegrade flow, followed by 90-95 percent stenosis immediately distal to origin of the vertebral artery, beyond the stenosis the left subclavian artery is free of significant disease and gives rise to medium size LIMA.
Right lower extremity angiogram:
Right common femoral artery is occluded chronically.
Right deep femoral artery receives flow via collaterals from the right hypogastric artery with retrograde filling to the right superficial femoral artery. There is 80 percent ostial stenosis of the right deep femoral artery.
Visualized proximal-mid right superficial femoral artery is fee of any significant stenosis with adequate flow.
Distal SFA/popliteal angiogram was not performed to preserve contrast use.
PROCEDURE NOTES:
The patient was brought to the cath lab in a resting and fasted state. The patient was prepped and draped in the usual sterile fashion.
Vascular access was obtained with the micropuncture kit, and modified Seldinger technique to the left common femoral artery, 5 French sheath was introduced.
Abdominal aortogram, and bilateral iliac angiogram, was obtained with a 5 French contra catheter positioned respectively to proximal abdominal aorta, and distal abdominal aorta in AP projection with power injection of 15, and 10 cc of contrast respectively.
Selective bilateral renal angiogram was obtained with a 5 French IM catheter, selectively engaging right, and left main renal artery.
Right lower extremity angiogram was obtained with a 5 French IM catheter positioned across the aortic bifurcation to the mid right common iliac artery.
Aortic arch angiogram was obtained with a 5 French pigtail catheter positioned to the distal ascending aorta in 30
degree LAO projection with power injection of 15 cc of contrast.
Selective right carotid angiogram was obtained with a 5 French JR4 catheter positioned to the ostial right common carotid artery in RAO projection.
Selective left carotid angiogram was obtained with a 5 French IM catheter positioned to the ostial left common carotid artery in LAO projection.
Selective left subclavian angiogram was obtained with a 5 French IM catheter positioned to the proximal left subclavian artery in AP projection.
For the entire procedure – 82 cc of contrast were used, patient was aggressively hydrated, received 400 cc of normal saline before and throughout the procedure, with plans for additional 400 cc normal saline infusion after the procedure.
LOCAL ANESTHETIC:
Local anesthetic to left groin region with Lidocaine 2%
PROCEDURAL APPROACH:
left femoral artery Merit Medical S-tv\AK 4FR minni access kit, Boston Scientific 5Fr BS Super Sheath 11cm
CONTRAST:
lsovue370- 119 mi’s
EQUIPMENT:
Merit Medical S-MAK 4FR minni access kit Boston Scientific 5Fr BS Super Sheath 11cm Navilyst 0.035x 145cm 3mmJ Wire
Boston Scientific 5Fr. Imager IIContra Flush catheter· Boston Scientific 5Fr. IM
Abbott Versacore Floppy Boston Scientific 5Fr. Str Pigtail Boston Scientific 5Fr. FR 4
LESION INFORMATION: MEDICATIONS:
Sedation Start Time 08:04 llf reeText11
{Narcotics/Sedation} Versed 1 mg IV
{Narcotics/Sedation} Fentanyl 50 mcg IV IV Bolus: .9 NaCl 250 ml total
Oxygen: 3 Umin via nasal cannula Heparin 2000 unit(s)
Wasted 1mg Versed and 50mcg Fentanyl llf reeText11 Sedation Stop Time 09:13 llfreeText"
AIR REST
ECG
AO 151/53 (88) SA AO 125/51 (78)
AO 153/56 (89)
07:56:34
08:16:23
08:20:07
08:50:08
CONCLUSIONS:
Severe diffuse peripheral arterial disease:
Chronic total occlusion of the right external iliac artery. and right common femoral artery. 95% stenosis of the mid left subclavian artery, immediately distal to the left vertebral artery . 60% stenosis of the mid abdominal aorta. immediately distal to the left renal artery.
Carotid artery disease:
Severe -critical stenosis of the ostial left common carotid artery
50% highly calcific stenosis of the left internal carotid artery
Renal Artery
99% stenosis of the left renal artery to the small-atrophic left kidney. No significant stenosis of the right renal artery.
RECOMMENDATIONS:
No Indication for renal artery revascularization.
Will plan to discuss management of the carotid, subclavian. iliac-femoral arterial disease with vascular surgery in regards to preferred option of medical treatment vs: interventional, surgical, or hybrid revascularization.
Add Plavix 75 milligrams daily to medical therapy.
I was thinking:
CPT 36252, 75625, 59, 75716, 36245, 59, 36223, 50, 99152 and 99153
Many, many thanks!!!
Happy 4th!! to all!
Study Result
DATE OF PROCEDURE: 03/08/2018
*
INDICATION FOR STUDY: NON-STEMI
*
PROCEDURE PERFORMED: LEFT HEART CATHETERIZATION
ABDOMINAL AORTOGRAM
VASCULAR ULTRASOUND OF THE LEFT MAIN
PCI OF THE LEFT MAIN WITH DRUG ELUTING STENT
PCI OF THE DIAGONAL ARTERY WITH A DRUG ELUTING STENT
**
*
CLINICAL SUMMARY: An 81-year-old male with past medical history significant for diabetes mellitus, hypertension, smoking, chronic kidney disease and bladder cancer who was recently admitted to Hospital with non-ST elevation myocardial infarction. *Diagnostic cardiac catheterization revealed severe left main disease. *The patient was transferred to Medical Center for further evaluation and management. *Based on patient’s clinical comorbidities, ST score, severe LV systolic dysfunction, cognitive impairment/dementia the heart team and patient’s family and patient decided to proceed with percutaneous revascularization. *Informed consent obtained.
*
PROCEDURE: * The patient was brought to the cath lab in stable condition. *Informed consent was provided after all risks and benefits were explained. *The patient was draped and prepped in usual fashion. 1% lidocaine was administered for local anesthesia. The femoral artery was accessed using micropuncture kit and a 7-French sheath was inserted in the left femoral artery. A*5 Fr sheath was placed in femoral vein. EBU 3.5 catheter was used to perform left coronary artery angiography. * A pigtail catheter was used to performed LV hemodynamics.**The pigtail catheter was also used to perform abdominal aortogram. Femoral angiogram was performed which revealed sheath was suitable for vascular device. Angioseal *vascular closure device was used for arterial hemostasis. *
*
FINDINGS:
*
Aortic pressure 120/80 mmHg. *
Left ventricular end-diastolic pressure was 14 mmHg. *
There was no significant gradient between left ventricle and aorta.
*
CORONARY CINE ANGIOGRAPHY: Coronary circulation is right dominant.
*
ABDOMINAL AORTOGRAM: *There is no significant disease in bilateral iliac and femoral arteries.
*
LEFT MAIN CORONARY ARTERY: The left main coronary artery has critical calcified/ulcerated 95% to stenosis.
*
LEFT ANTERIOR DESCENDING CORONARY ARTERY: Ostial/Proximal 50-70% stenosis. The left anterior descending coronary artery gives off a large diagonal artery. *The diagonal artery has proximal 90% stenosis. *The LAD itself continues as a small to medium caliber vessel with diffuse 40% disease.
*
PCI DETAILS: A 7-French, EBU3.5 guide catheter was used to intubate the left main. A short Runthrough wire was used to cross the lesion placed distally into diagonal artery. *A BMW wire was also placed into left circumflex artery. *Predilation of left main lesion was performed with 3.0 noncompliant balloon. *This is followed by deployment of a drug-eluting stent Synergy 2.5 x 24 mm in diagonal 1. *Stent was post dilated with stent balloon. *This is followed by deployment of a drug-eluting stent Synergy 3.5 x 20 mm extending from left main into left anterior descending artery. *This stent was post dilated with 3.5 and 4.0 noncompliant balloon. *Intravascular ultrasound was used for stent size and length. *Intravascular ultrasound revealed well expanded and well opposed stent. *There was no significant plaque shift towards left circumflex artery. *There was no significant stenosis there was no dissection and there was no perforation.*
*
IMPRESSION:
*
1. Severe left main disease which was treated with single drug-eluting stent (provisional stent technique) under intravascular ultrasound guidance.
*
2. Severe diagonal disease which was treated with single drug-eluting stent.*
*
RECOMMENDATIONS: *
*
1. Dual antiplatelet therapy.
*
2. Aggressive medical therapy and risk factor modification.
____________________________________
PAST MEDICAL HISTORY
He has a past medical history of Anxiety; Bladder cancer; Chronic kidney disease (CKD), stage III (moderate); Depression; Diabetes; Hyperlipidemia; Hypertension; Nephrolithiasis; Prostate cancer; Restless leg; and SVT (supraventricular tachycardia). He has a past surgical history that includes hx hernia repair (Bilateral); hx knee replacement (Right); and tonsillectomy.
I couldn’t find a CPT code for the above procedure. The diagnosis is Imperforate anus, urethral fistula.
Procedure Performed: Laparoscopic mobilization of rectum and separation of urethral fistula, perineal approach for repair of high imperforate anus with pull-through. Surgeon also did on-table colostogram. The closes code I can find ranging from 46735 to 46742. However, they all are open techniques w/different approach. Do I have to use the unlisted code? What’s about the colostogram? Can we charge for this? Please help!
Thanks for any inputs and have a happy Friday:)
Angie
The patient presented for evaluation of possible gallstones. Our study concluded the patient did not have gallstones. Is this diagnosis still acceptable to assign to this charge? Or should it be changed to something else?
Any and all insight is greatly appreciated!