September 2017 Q & A

Question: Limbs AV Fistula Declot & Stenting Failure; TPA and Repeat Stent for Extravasation

AV left forearm graft fistulogram showed extensive thrombus in main draining vein up to the level of the distal third of the humerus. Crossing sheaths placed. Angiojet catheter used to treat arterial and venous anastamosis. It worked for arterial but not venous. Angioplasty of arterial anastomosis, with arterial flow re-established. Stent was placed across venous anastamosis to improve outflow. Patient continued to clot despite administration of 10,000 units of heparin during the procedure. Multiple passes again made with the angiojet. Flow was not re-established.

August 2017 Q & A

Question: Repair of EVAR with Deployment of 2 Gore Excluder Limbs

This patient developed a type III endoleak due to component separation of the left iliac limb from a prior EVAR. To repair this, our physicians first used an Excluder limb across both graft defects followed by a second Excluder limb in the patient's iliac, to bridge the separation of components. I would normally code this with 34825, 75953.

However, I am not sure how to code for a second graft in this case or if I can code for it at all because I am not positive that the second graft is considered a separate vessel and qualifies for the 34826. There is no mention of it being placed in either the external or internal iliac.

July 2017 Q & A

Question: Superior Mesenteric Artery to Rt Hepatic Artery

A 5 Fr sheath was placed and attached to a heparinized saline infusion. Exchange was made for a SOS catheter and selective DSA performed in the superior mesenteric artery. Superselective catheterization of the replaced right hepatic artery was then performed using a 3 Fr Progreat Microcatheter and wire. Can a catheter reach the right hepatic artery from the SMA or does the catheter need to go through the celiac artery?

June 2017 Q & A

Question: Coarctation of Aorta and Bicuspid Aorta Valve

I have a provider that is is trying to tell us that if a patient has a coarctation of the aorta and a bicuspid valve then we need to bill the congenital CPT codes. I noticed that you answered a similar question in March, but I was wondering where you got your information so I can provide that information to my provider.

May 2017 Q & A

Question: 96374 with an Ablation