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Procedures:
1. Suprarenal aortogram
2. Bilateral LE Angiogram
3. 3rd order catheter placement (Selective L LE angiogram from L SFA)
4. Laser Artherectomy with 2.0 laser catheter of the mid-distal Left SFA
5. Angioplasty of the left popliteal artery with 5.0x120mm DCB Spectranetics
6. Stenting of the mid-distal left SFA with 6.0x120mm DES Zilver
7. Moderate sedation supervision
Anesthesia: lidocaine 2% Sedati on: Versed and Fentanyl
Moderate Conscious sedation was provided under my direct supervision with the sedation trained nurse using 2 mg of IV Versed and SO mcg of IV Fentanyl.
Start time was 0935 and end time was 1145 . There were no complications. See hospital trained nurses sedation sheet I signed and dated for the completed procedure
Access Site: Right femoral artery 6F
DESCRIPTION OF PROCEDURE: Using micropuncture needle and ultrasound guidance, we placed a 6-French sheath via Seldinger technique to the left common femoral artery. A catheter was inserted into the aorta and an aortogram was performed. The Omni Flush catheter was then pulled down to the aortic bifurcation and a bilateral runoff was performed. The results of the angiogram are listed below. Next, the Omni Flush catheter was selectively placed in the proximalright SFA and contrast injections of the right leg were performed to further evaluate the infrapopliteal disease.
Findings:
Aortogram
– Patent b/I renal arteries
– Mild distal aortic disease
Right Lower Extremity
1. Common Iliac artery patent
2. Internal Iliac artery patent
3. External Iliac artery patent
4. CFA patent
5. Profunda patent
6. SFA patent
7. Popliteal patent
8. TP trunk patent
9. AT artery patent
10. PT artery patent
11. Peroneal artery 100% occluded ostially
Left Lower Extremity
1. Common iliac artery patent
2. Internal Iliac artery patent
3. External Iliac artery patent
4. CFA patent
5. Profunda patent
6. SFA Mid 70-80% disease; Distal 100% occluded
7. Popliteal proximal 100% occluded; Mid 80% disease
8. TP trunk patent
9. AT artery patent
10. PT patent
11. Peroneal artery severely diseased
Intervention:
Given disease in the left superficial femoral artery and popliteal artery, the decision was made to Intervene on that vessel. The short 6 French sheath was exchanged for a long 6 French sheath and placed into the proximal superficial femoral artery.
Once the sheath was in the proximal superficial femoral artery a run-through wire was used to circumvent the lesions In the superficial femoral artery and popliteal artery. The wire was placed distally into the TP trunk. Laser arthrectomy was decided upon in origin debulk the lesion. A Spectranetics 2.0 laser catheter was used to to laser arthrectomy of the mid to distal left superficial femoral artery. After multiple runs, an angiogram was done which showed significant improvement
in disease and improvement in flow. A 5.0 x 120 mm drug-coated balloon was then used to angioplasty of the superficial femoral artery and popliteal artery. Once that was completed, an anglogram was done which showed good flow in the vessel; however there appeared to be a small dissection in the mid to distal left superficial femoral artery. A 6.0 x 120 mm Zllver was placed In the mid to distal portion and an angiogram was done showing no perforations or dissections and good flow in the vessel.
The long 6 French sheath was then exchanged for a short 6 French straight over a J-wire. Groin shots were done which showed that we are above the bifurcation and noted there was no significant calcification at the site of entry. Angio·Seal was deployed with good hemostasis.
Oosure Device: Angioseal
EBL: less than 25 ml Complications: None lines: None Specimens: None Condition: Stable
NP:
Critical limb ischemia of the left foot
– ASA, plavix and lipitor
– Monitor and bedrest for 3 hours. D/C Home at 630pm
– IVF
Call on AAPC Coder and NCCI code pair edits for support. Many procedures in the CPT® code book are designated “separate procedures,” but that doesn’t mean you can report those procedures separately in every case. First, you must consider other procedures performed during the same encounter. “Separate” Might Not Mean What You Think It Does […]
The post Separately Report a “Separate Procedure” with Confidence appeared first on AAPC Knowledge Center.
Procedures:
Procedure: Left Intra-articular Hip Joint Injection with Ultrasound Guidance
The procedure, alternate treatment options, risks and benefits were explained to the patient and informed consent was obtained. Bony landmarks, femoral vessels and joint space were identified using the ultrasound device. The area was prepped in the usual sterile fashion with betadine. Local anesthesia achieved using Ethyl Chloride spray. Lidocaine 1% without epinephrine (10mL) and Dexamethasone 8mg was injected into the joint using a 22g spinal needle (3.5) from an anterior approach under ultrasound guidance.
EBL: Less than 5mL
Patient was given standard post procedure instructions and return precautions given. The patient tolerated the procedure well without complications.
Thank you
PROCEDURE:
1. Percutaneous right common femoral artery access with ultrasound guidance.
2. Cannulation of aortic arch.
3. Arteriogram of aortic arch.
4. Selective cannulation of right common carotid artery.
5. Angiogram of right common carotid artery.
6. Selective cannulation of left common carotid artery.
7. Angiogram of left common carotid artery.
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DESCRIPTION OF PROCEDURE:
Patient was taken to the angiography suite and placed in a supine position. Mild sedation was given and the groins were prepped and draped in a sterile manner. 1% lidocaine was used to infiltrate the surgical area. Percutaneously, the right common femoral artery was accessed under direct ultrasound guidance. A guidewire was inserted under fluoroscopy. Over the guidewire, a 5-French introducer was placed. Over the guidewire into the introducer a 5-French pigtail catheter was inserted and guided to the proximal aortic arch. An angiogram was performed of the arch. Once angiogram was performed, the pigtail catheter was removed and was exchanged to a Vitek catheter over a Glidewire. Selectively the right common carotid artery was accessed and the catheter was advanced into the right common carotid artery. From this position an angiogram of the right carotid artery was done. The guidewire was reinserted and the catheter was backed out into the arch and selective cannulation of the left common carotid artery was performed and the catheter was advanced into the left common carotid artery. From this position an angiogram was performed of the left system. During the angiogram of the left and the right common carotid arteries, multiple views were taken including oblique view and AP and lateral views. The catheter was then removed and the introducer was removed. Hemostasis was obtained by direct pressure for 20 minutes. Dressings were placed and the patient was then transferred to the recovery room stable. No complication was seen. The estimated blood loss was minimal.
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FINDINGS:
The patient was seen to have a normal aortic arch with the great vessels. There were no abnormalities and stenosis.
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On the right side, the common carotid artery was widely patent along with the external carotid artery. The internal carotid artery shows atherosclerotic changes at its origin and after reviewing several views there is no hemodynamically significant narrowing.
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On the left side, the common carotid artery is widely patent. The internal carotid artery itself shows mild disease with narrowing of approximately 15-20%. The external carotid artery, however, has a high-grade stenosis of greater than 90%, short segment at its origin.
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At this time, the patient will follow up in the office for further consultation and discussion of the findings as well as future management plans.
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I have a question regarding I/R, I am noticing a pattern with our physicians that when they indicate a reason for the test they are writing something like this.
Reason for Test – H40.1232 – low-tension glaucoma, bilateral moderate stage, Monitor for progression.
Reason for Test – H40.013 – Open-Angle with borderline findings, low risk, Monitor for progression
I am trying to teach them the correct way to document a chart, all the other pieces of the I/R are good, I am just not sure if something like this is okay.
Any help and/or feedback would be greatly appreciated.
laura
I am wondering if anyone could clarify the correct way to document a Final Report in the ED.
To my knowledge – especially when dealing with Medicare Claims; a Preliminary Radiology Report should not be a part of a Final ED Note. In other words – the Radiology Report should be finalized as well, when it is interventional and a part of the diagnosis decision making process. Am I correct in this thought or is it incorrect? Please enlighten me.
Thank You –
When a Resident working in a hospital ED orders a 12 lead EKG and then sends to the strip to be read by the hospital’s Cardiologist,
does the Cardiologist, who is doing the Interpretation and Report without any additional input from the Resident, not add a GC modifier
to the CPT 93010? Or does the GC get added because the Resident produced the EKG strip and will use the report to arrive at the final DX
for the Medicare patient?
Thanks so much for your help!
Brian
Are your clinicians reporting patient relationship codes on their Medicare Part B claims? The HCPCS Level II modifiers are voluntary this year, making it a good time to get in practice. What Is the Purpose of Patient Relationship Categories and Codes? The Medicare Access and CHIP Authorization Act of 2015 (MACRA) requires the Centers for […]
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