Ask Dr. Z

A right femoral PTFE graft was punctured, fistulagram and central angioplasty were performed due to a pseudoaneurysm along the right arterial limb and common iliac stenosis. A direct needle injection of thrombin under US guidance into the pseudoaneurysm sac was performed. Can this be coded as 36909 or 36002/76942 with modifiers? 

In the code description for 34705 it states all angioplasty and stenting performed from the level of the renal arteries to the iliac bifurcation is included. When is it appropriate to bill for renal artery stents?

a 0.014 wire was passed into the peroneal artery, which was single vessel runoff and intravascular us was performed of the peroneal artery, tib trunk, popliteal artery, and the sfa. the pt has 72% stenosis in the peroneal, 67% stenosis in the tib trunk, 70% stenosis in the popliteal artery & 73% stenosis in the sfa.

a laser atherectomy was performed across the sfa, pop, tib trunk & peroneal artery followed by balloon angioplasty using 2.5 mm balloon in the peroneal artery and tib trunk & a 5mm balloon in the pop artery and sfa.

findings: pt's aorta and iliac vessels appear widely patent. the pt has a stent in the rt sfa with intrastent stenosis. also evidence of popliteal stenosis & single vessel runoff via ant tibial artery. left sfa stenosis including intrastent pop, tib trunk, & peroneal artery stenosis which was single -vessel runoff.

we billed 37229 lt, 37225 lt, 37252, 37253 but uhc isnt paying 37229 based on this doc. does anything look like 37229 should NOT be paid

We received a claim denial for excessive procedures based on the following codes: 35355-50, 37221-50, 37236. The patient had bilateral LE AS with life-limiting claudication and severe proximal aortic stenosis. Our physician performed the following procedures: bilateral iliofemoral endarterectomy with patch angioplasty, aortogram and bilateral iliac angiograms; placement of an 8 x 39 VBX stent within the proximal abdominal aorta; SWL of the left common and EIA; placement of a 6mm x 10cm Viabahn stent in the left EIA; placement of a 7 x 40 bare metal self-expanding stent in distal common and proximal EIA; placement of a 7mm x 15cm Viabahn stent within the right common and EIA.

Are the endarterectomy and stenting procedures bundled, as in two treatments in one vessel? If so, which should be coded? Did we miss coding any of the procedures? Please advise on the correct coding for this case, and why. Thank you.

Op note states: "Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological S&I; US-guided left common femoral artery puncture using micropuncture needle; R lower extremity angiogram; IVUS aorta, right common iliac artery, right external iliac artery, right common femoral artery, right superficial femoral artery, right popliteal artery, right tibioperoneal trunk, right anterior tibial artery, right dorsalis pedis artery, right lateral tarsal artery, right peroneal artery, right posterior tibial artery; IVUS left common iliac artery, left external iliac artery, and left common femoral artery. Angioplasty, atherectomy, and stenting performed right leg, mild disease found L leg. No angiography of left leg performed." 

How many IVUS can be coded? Our coder states one per leg, code description states per vessel, but MUE is 5. Provider wants IVUS coded for every vessel. What guidelines are available to support correct coding?

If a patient has a shockwave lithotripsy and stent to the external iliac and then also has angioplasty and stent of the common iliac, should this be coded with C9765 plus 37223? I am getting an edit that 37223 cannot be billed without the base code, but 37223 seems the most appropriate.

"Stenting of the restrictive atrial sepal communication was next performed. We attempted to upsize the 5F short sheath in the right femoral vein to a 7F Mullins sheath. However, resistance was encountered with advancing the Mullins sheath a short distance into the body. A hand injection of contrast through the sheath into the RFV showed significant upstream stenosis of the right external/internal iliac veins. 3 mm x 2 cm Evercross balloon was advanced into the Mullins sheath, and inflated a total of 3 times across the right external/internal iliac veins and then repeated w/4 mm x 2 cm balloon due to difficulty passing sheath. Following angioplasty, and over this wire, the 7F Mullins sheath was able to be advanced past the area of stenosis to the RA. Genesis stent was positioned across the atrial septum."

Can intervention of iliac stenosis be billed with TIS (33745) when being treated to advance a shunt?

My doctors (co-surgeons) did bilateral iliofemoral endarterectomy then percutaneous stented bilateral common iliac arteries and angioplasty of bilateral external iliac arteries. He wants to bill 35355-50-62, 37221-50, and 37222-50. I don't agree. I believe this should be coded as 35355-50-62 and 37221-50-51. I feel any PTA in EIA is inflow, but he doesn't agree, as it was proximal EIA and endarterectomy was distal EIA and CFA. The other doctor I haven't seen yet, but he wants to bill 35355-62-50, 37221-80-50, 37222-50-80, so I think he is of the same opinion. Which of us is correct/wrong and why?

"Attention was then turned to the right groin. Under ultrasound guidance, access to the right common femoral vein was obtained. A sheath was placed. Next, a 20 mm Abre stent was deployed in the infrarenal inferior vena cava. Next, in a kissing, double-barrel fashion, two 14 mm Abre stents were deployed extending from the inferior vena cava into both common iliac veins. Post-deployment angioplasty was then performed with 14 mm balloons. Next, two 14 mm Abre stents were deployed extending from both common iliac veins to both external iliac veins. Post-deployment angioplasty was then performed with 14 mm balloons. Completion bilateral lower extremity ascending venography was then performed." 

No mention of catheter placement is made in this report. Can we assume catheter placement and code it? Or does it need to be documented? I have always been taught that if it isn't documented it didn't happen, but the IR coders tend to infer the cath placement.

The provider couldn't cross the lesion in the right superficial femoral artery. The question is, can I still code for 37224 or not??

"Ultrasound-guided left radial percutaneous arterial access. Iliac and right leg angiogram, catheterization of aorta and femoral artery, supervision and interpretation. Intra-arterial administration of nitroglycerin and verapamil, ultrasound-guided right dorsalis pedis percutaneous arterial access, catheterization of right anterior tibial artery, and percutaneous closure utilizing TR band."

Would codes 35371, 37221, and 34201 be appropriate to use? I do not think 35371 is billable.

"Vertical incision left CFA exposed opened femoral Fogarty balloon multiple passes through iliac thrombus removed pulse restored femoral opened back wall was mended w/ multiple stay sutures decision made to perform patch angioplasty bovine pericardial patch sewn end to side, prior to completion of anastomosis vessels backbleed poor backbleed from left SFA Fogarty catheter passed down SFA return of small chronic thrombus after this backbleeding excellent, angio left iliac residual thrombus distal portion CIA stenosis distal to stent in EIA selected stent advanced to level of mural thrombus deployed w/o difficulty attention turned distally a VBX balloon expandable endoprosthesis deployed w/o difficulty angio reveals excellent flow patch angioplasty completed."

My surgeon placed an intact vascular tack into the proximal peroneal artery for dissection after he did angioplasty for occlusive disease. Would this be reported with an unlisted code (37799)? I am not finding information on coding interventions done on the lower extremity vessels for dissection. No aneurysms. Details are as follows: "The peroneal was angioplastied with a 3 mm balloon, there was a dissection, and intact tacks were placed in proximal peroneal. The left iliac was stented with an Absolute Pro 10 x 60 and post dilated. Completion showed excellent flow through the peroneal. The wires and catheters were removed, and the long sheaths were exchanged for short sheaths. Protamine was given for reversal. Pressure was held at all access sites."

Is it allowable to code a right common femoral endarterectomy, right common femoral to left common femoral bypass, and a right external iliac angioplasty? If so what are the codes?

I'm not seeing any NCCI edits with C9765 (lithotripsy, balloon right superficial femoral), 37221 (iliac), and 37224 (femoral angioplasty). So would it be appropriate to charge these together when provided during the same session?

Received a denial stating that code 35351 was documented in the record. Here is what was documented: "9 x 40 balloon angioplasty balloon was advanced into the common iliac artery and used to provide control. Distal external iliac artery was clamped distally. Longitudinal arteriotomy was made with a 12 blade and extended proximally distally with the Potts until adequate endpoints have been achieved. Thin endarterectomy plane was created and plaque was passed off. 5-0 Prolene and bovine pericardial patch was used to create left external iliac patch angioplasty. There was excellent distal external iliac pulse at this point after balloon control was withdrawn."

Patient has AAA and has stenosis of femoral and iliac arteries. Documentation states the patient had bilateral external iliac artery angioplasty to facilitate advancement of aortic main body. Would that be included in the aneurysm repair, or can I bill the angioplasty separately? There is documentation that the patient could need femoral endarterectomy in the attending note prior to surgery.

Can I bill an iliac angioplasty done during an Impella placement? I have found no guidance on this.

How would you suggest I bill recanalizations performed with multiple CTO wire without angioplasty? 1) Recanalization of the left iliac vein (successful). 2) Multiple attempts to recanalize the PDA to create AO-PA shunt (unsuccessful). Should we reporte unlisted code for both or 37248-53/37246-53?

Patient with bilateral 70% common iliac stenosis and 80% bilateral external stenosis treated with combination of bilateral orbital atherectomy and bilateral drug-coated balloon angioplasty. Would this be coded as 37220-50, 37222-50, 0238T x 4? Or 37220-50, 0238T-50 x 2? Thank you!

The patient is brought to the cath lab for possible SMA ischemia, and the MD performed angioplasty at the access site prior to the diagnostic study. He documented, "Severe right external iliac stenosis (90%) requiring POBA with a 7 x 2 balloon to access the aorta." Would you bill for the angioplasty?

"With a NaviCross catheter and a stiff angled Glidewire, access was ultimately gained to the inferior vena cava, confirmed by injection in the inferior vena cava. The wire was then exchanged through the catheter for a Storq wire. The catheter was then withdrawn. A 7 mm percutaneous transluminal balloon angioplasty was performed to the level of the inferior vena cava, all the way to the level of the femoral vein, through the external iliac vein and common iliac veins via inflations to 10 atmospheres at 30 seconds x4. Venous balloon angioplasty was performed in order to expose more fibrin receptors in this chronic DVT setting for improved thrombolysis." I want to verify that the angioplasty cannot be coded. It was not done specifically for maceration, which is not allowed, but the reason for it does not seem justified for coding either.

When the procedure is ordered to treat ED, and from the femoral artery the catheter is selectively placed into the internal iliac to the pudendal and then finally into the penile artery where angioplasty is performed, should codes 37246 and 36247 be reported? Or should codes 37788 and 36247 be reported? Then how about atherosclerosis was the reason for the ED and it was treated with angioplasty... would the code then be 37220?

1. Bilateral iliac artery angioplasty 2. Abdominal aortography with bilateral iliac artery angiography 3. Failed attempt to place Endurant stent graft on either side (i.e, right CFA or left CFA). Procedure terminated. Is the aborted stent graft coded with a -53 modifier, or can you only code the successful iliac PTA?

"Procedures performed are: 1) Ultrasound-guided right femoral access. 2) Aortoiliac arteriogram. 3) Left lower extremity arteriograms with runoff. 4) Second order cannulation of the left popliteal and superficial femoral arteries. 5) Drug-coated balloon angioplasty of the left superficial femoral artery. Provider documentation: An Omniflush catheter was placed into the visceral segment of the aorta. Aortic and bilateral iliac arteriogram was performed. This revealed a widely patent infrarenal aorta. Patent common iliac arteries on both sides. Patent external iliac arteries and patent bilateral proximal internal iliac arteries. Internal iliac arteries after bifurcation into the anterior and posterior divisions had segmental mild to moderate stenosis. The catheter was then advanced into the left distal external iliac and left lower extremity arteriograms performed. Cath advanced to superficial femoral artery, angio performed and drug coated balloon angio was performed." Can we code 36246-LT for left external iliac angio, 37224, 75625, and 75710? 

Patient had a thrombectomy and revision of aorto-bi-femoral graft. After patch angioplasty the patient had exposure of graft, and physician did a sartorius muscle flap to cover the graft. Would this be coded as 14021 or 15738? See op note regarding this enclosed: "Because of the redo nature and the significant amount of prosthetic in the groin, I proceeded with a sartorius flap. This was done in the usual fashion by freeing up the sartorius muscle from the anterior superior iliac spine and turning the sartorius on top of the previously endarterectomized and patched repair. I placed a drain in the lateral portion of the wound. Closed the drain in multiple layers after securing the sartorius flap to the groin."

"LCF artery punctured w/ 6 French sheath. Aorta was catheterized and angio obtained, no stenosis. Rt common iliac, external iliac, common fem, superficial and popliteal were catheterized and angiogram of each segment obtained. Vessels patent except superficial fem that had 60% stenosis. Distal runoff revealed patent anterior tibial to the foot. Rt tibioperoneal was catheterized and angiogram revealed 60% stenosis, distal runoff was peroneal artery only to the foot. Pt given 6000 units of heparin and sheath place up and over to the rt fem. Angioplasty of the tibioperoneal trunk and superficial fem performed with 3.5mm and 5mm balloon and post angioplasty both vessels were patent. Catheterization of lt external iliac performed and was patent. Sheath removed and puncture site closed." Billed as 37228, 37224, 75710, 75625, 75774. I'm confused with the angiograms. Can you explain why these are correct? Our clinic struggles with 75625/75630 and 75710/75716 and 75774 is always an issue.

My provider described doing an intervention in a manner that I can't really put a code to. Is there a code for the following? "I then used an 8 x 80 mm balloon and performed bilateral common iliac artery angioplasty with the balloon straddling over both common iliac arteries."

I know you answered a similar question in 2012, but I'm wondering if the recommendation is still the same. We performed an EVAR in which the SMA was also stented. A few weeks later the patient returned to us for evaluation of a possible endoleak and evaluation of what appeared to be a stent fragment in her left external iliac artery. A diagnostic study was performed, and it was determined that her SMA stent had fractured and migrated to her left external iliac artery. The stent was balloon dilated in place in the external iliac. The stent was not otherwise manipulated, and no other interventions were performed. How would you bill for the balloon dilation of the stent?

Is angioplasty of the right common iliac billable when done for protection? Note states: "We now angioplastied the right common iliac artery with a 6 mm balloon for protection. We brought a wire and catheter into the aorta from the left side. We performed over-the-wire thrombectomy of the left common iliac artery, removing a moderate amount of old appearing debris. We performed two thrombectomies with audible inflow. We then stented the left common iliac artery into the aorta using a 7 x 38 mm iCAST covered stent. The right-sided balloon was deflated."

What codes should be used for endovascular reconstruction with bifurcated vascular prosthesis, bilateral common iliac artery angioplasty with balloon expandable stents? It was the same technique as an AAA repair, using the same modular bifurcated device (34803), with bilateral cutdowns, but with an atherectomy performed in the obstructed right CIA to gain access to the aorta prior to deploying the prosthesis. Additionally, bilateral balloon expandable LifeStream stents were placed, within the limbs, due to residual stenosis. However, this procedure was performed for a total occlusion of the right CIA, subtotal occlusion of the left CIA, total occlusion of the left EIA with severe and diffuse aortic obstructive disease. The patient has Leriche’s syndrome. According to the CPT book, code 34803 is exclusive to aneurysm repair. Should we use an unlisted code? I have absolutely no idea how to code this. Also, are the associated radiology services, cut-downs and catheter placements billable as with a AAA? 

The physician accessed the right and left common femoral veins and performed angioplasty in the right and left common iliac vein and the left external iliac. We reported codes 37248 and 37249 x 2. Would you also report codes 36005 x 2 or 36000 x 2?

"Patient with DVT right-sided common femoral vein, popliteal vein, common iliac vein, and left-sided common femoral vein and common iliac vein. Placement of 50 cm lysis catheter in vena cava via left-sided popliteal and right-sided popliteal posterior approach (37212, 36010-50). Balloon angioplasty of IVC (37248). Balloon angioplasty right-sided common iliac vein, external iliac vein, common femoral vein. Balloon angioplasty left-sided common femoral vein, common iliac vein." Would we submit code 37249 x 2 per extremity? 

Help please! I'm coming up with codes 37221 and 35656... do you agree? "We did a longitudinal arteriotomy through the profunda into the common femoral patch, and noticed a very tight stenosis of the origin of the profunda artery. We ran a 4 French Fogarty embolectomy catheter up the iliacs, removed a large amount of thrombus, and re-established some flow back into the femoral. A 7 French sheath was placed into the femoral, and an angiogram to look at the aorta and iliacs showed a long segment left iliac occlusion. We placed an iCAST stent 8 mm diameter, 38 mm length, at the origin of the common iliac on the left, and then angioplastied the remainder of the iliac common femoral with an 8 mm balloon. We then sewed a Hemashield patch over the profunda for the profundoplasty portion. Left lower extremity angiogram showed reconstitution of left popliteal artery above the knee with two-vessel runoff to foot. There wasn't good pulse to foot, so we did a left fem-pop bypass. There was still narrowing at the anastomosis, so we ballooned it." 

This is a FEVAR with a right iliac dissection and a left distal iliac avulsion. "RCIA dissection was treated using LT radial approach & RCF access for through/through access across LT iliac occlusion. From the LT sheath angioplasty was performed to the LCIA/LEIA - allowing access for sheath. 3 vessel FEVAR (34847) performed. With placement of LT iliac limb, avulsion is revealed and the decision was made to place conduit- subsequently LCIA & LEIA overlapping stents were placed to previous iliac limb and brought down to the groin incision. Placed RT ipsilateral extension (or limb?) terminating within the REIA beyond the level of known occlusion. Returned to LCF to perform endarterectomy-endpoint was created. Next, a Viabahn graft was trimmed to size to allow end-to-end anastomosis with the LCFA." We weren’t sure if we could bill 37221 for the stents on the LEFT. Also, for the avulsion on the LEFT, 35371-endarterterecomy with graft included or would it be 35286 blood vessel repair with graft?

Our physician treated an abdominal aortic aneurysm with a Gore Excluder graft (34802) and also an iliac aneurysm with a branced iliac device at iliac bifurcation into the hypogastric and external iliac (0254T). The hypogastric artery had severe stenosis at the origin, so he also placed a covered stent and did angioplasty. Is the hypogastric stent a billable service, or is it considered the deployment zone of the iliac branched device at bifurcation? If it is billable, would it be an extension limb 34825 (which I don't believe so) or a stent/angio with 37236?

For venous lower extremity angioplasty and stents, do they follow the same territory rules as lower extremity arteries (iliac, femoral/popliteal, and tibial/peroneal territories)?

"Right common femoral accessed and threaded into AA. Aortogram was performed with findings documented. Wire was passed into left external iliac, and lower extremity arteriogram was done with findings of stenosis. Rubicon cath was passed over wire into superficial femoral on left side. Repeat arteriogram was done for intervention. I performed thrombectomy of left fem pop segment. After this, atherectomy of fem pop segment was done on left. A drug-eluting balloon was passed over wire, and angioplasty was performed of fem pop segment. Arteriogram confirmed excellent results. Balloon was removed and sheath pulled back to right iliac. Following this, a balloon was brought up on right side into proximal right common iliac, and balloon mounted stent was brought up on the left side. Stent was deployed in proximal left common iliac. This done as right-sided balloon brought up for support." Provider wants to bill 37221, 37225, 37220, 37184, 75710, 75625. Im not sure when to bill 75710 & 75725 with the procedures. Would I bill 36247?

What is meant by a complete runoff? Does the imaging have to be to the toes in order to bill for the complete runoff? "Both groins were prepped right common and left common femoral arteries were accessed; a 5 French sheath was placed into each vessel. There was high grade stenosis in the left common iliac artery and multiple stenosis in the external iliac artery, common femoral artery, and beginning of the SFA. On the right there was high grade stenosis of the RCA and occlusion of the RSFA and CF . We performed angioplasty across these areas using a 5 mm balloon x 200 in length and then deployed 8 mm x 57 in length expandable stents across the CIAs. We then deployed a stent across the ext iliac, CF, and the beginning of the SFA on both left and right sides and post-dilated these areas. After this, repeat contrast study revealed a widely patent iliac arterial system as well as common femoral arteries, SFA, and profunda femoris." Would the correct codes be 37226-50, 37221-RT, 37223-RT, 37221-76-XU-LT, 37223-XU-LT, and 75716-26-XE? In this case would it support the runoff?

A 5 FRENCH KUMPE CATHETER AND GLIDEWIRE WERE USED TO TRAVERSE THROUGH THE LEFT COMMON ILIAC ARTERY. DESPITE MULTIPLE PROBING, THE GUIDEWIRE COULD NOT BE ADVANCED INTO THE DISTAL ABDOMINAL AORTA. DURING THE MANIPULATION, THERE WAS ANTEGRADE DISSECTION NOTED INVOLVING THE DISTAL COMMON ILIAC ARTERY, SPIRALLY DOWN TO THE EXTERNAL ILIAC ARTERY. GIVEN THE SPEED OF DISSECTION, WE HAD TO QUICKLY INTERVENE. AN 8 X 60 MM SELF-EXPANDABLE STENT (ABSOLUTE) WAS QUICKLY DEPLOYED IN THE LEFT DISTAL ILIAC ARTERY TO PREVENT FURTHER DISSECTION. SUBSEQUENTLY, ANOTHER 8 X 40 MM SELF-EXPANDABLE STENT WAS OVERLAPPED INTO THE COMMON ILIAC ARTERY TO TREAT THE INITIAL POINT OF DISSECTION. GENTLE ANGIOPLASTY WAS PERFORMED WITHIN THE STENTS, WITH AN 8 X 40 MM BALLOON CATHETER. POST INTERVENTION CONTRAST INJECTION SHOWED RESTORED WIDE PATENCY THROUGH THE LEFT ILIAC ARTERY. THE PATIENT HAS BEEN ON THE TABLE FOR 2 HOURS. IT WOULD NOT BE SAFE TO ATTEMPT CROSSING THE LEFT COMMON ILIAC ARTERY IN THIS SETTING. THEREFORE, WE DECIDED TO TERMINATE THE PROCEDURE. Code 34900 or 37236 1 time.

Can you provide coding assistance for this case? "Procedure(s): 1) Ultrasound-guided access antegrade and retrograde left femoral AV graft. 2) Fistulogram with central venography. 3) Arteriography with iliofemoral runoff. 4) Angioplasty AV graft, arterial and venous anastomoses with 6x40 mm non-compliant balloon. Intraop Report: Using local anesthesia, ultrasound guidance, and a micropuncture system, the left femoral AV graft was accessed antegrade and retrograde. The transitional sheaths were immediately upsized to short 7 French sheaths. Contrast was injected to perform fistulogram with DSA runs visualizing the fistula in its entirety as well as the central veins in multiple views. This revealed venous outflow occlusion. Injection from catheter placed into the left iliac artery revealed focal stenosis at the arterial-graft anastomosis. These areas were angioplastied per above for 3-minute inflations."

2017 CPT book, P247, “Codes 36907 and 36908 describe procedures performed through puncture(s) in the dialysis circuit. Similar procedures performed from a different access (e.g., common femoral vein) may be reported using 37248, 37249 or 37238, 37239.” 2017 CPT book, P255, continues to say “37248 and 37249 describe transluminal balloon angioplasty in a vein excluding the dialysis circuit (36902, 36905, 36907) when approached through the ipsilateral dialysis access.” I am confused about these two instructions. Can I understand in this way, for example, in a patient with dialysis circuit, if central dialysis segment angioplasty (e.g., external iliac vein) is performed through puncture in the common femoral vein, shouldn’t the procedure be coded with 36907 instead of 37248? Because the procedure is performed through dialysis circuit. (common femoral vein is part of the peripheral dialysis segment, which is part of the dialysis circuit). Only when the procedure is done in veins other than in the dialysis circuit, should the code 37248 be used?

Patient has in-situ bypass (fem-pop). Patient also has angioplasty of the ipsilateral common, internal, and external iliacs. The common femoral was exposed, and dissection was carried down to the inguinal ligament. The LCFA was then dissected and controlled, then the physician exposed the distal popliteal and prepared for bypass. The physician then dissects the in-situ vein. He prepared the in-situ vein for bypass, then turned his attention to performing the endovascular part of the case. Through the exposed common femoral artery, a micropuncture needle is inserted…” and he performs angioplasty of the LCIA, LIIA, LEIA. He clamps the LCFA distally with clamp and proximally with clamp, then turns his attention back to the actually in-situ bypass. Can I bill out the in-situ bypass with the iliac angioplasties? I am saying NO, they can’t be billed. I need someone else’s opinion.

"The left femoral artery was accessed under fluroscopic guidance with a micropuncture needle, wire, then sheath. A 4 French sheath was inserted over a wire. A wire, then catheter was inserted into the aorta. An aortoiliac arteriogram was performed. A bilateral lower extremity arteriogram was performed. The right iliac, then common femoral artery was selectively catheterized, and an arteriogram was performed. The right superficial femoral artery was selectively catheterized and angiography performed. Two severe stenoses were identified in the right popliteal artery, in the P1 and P2 segments. An up-and-over 5 French sheath was inserted over the wire into the right superficial femoral artery after 3000 units of intravenous heparin was administered and three minutes allowed to elapse. Balloon angioplasty of the right popliteal artery was performed using a 5 mm cutting balloon." How would you code the S&I: 75630 or 75625, 75716?

"Abdominal aortogram with left lower extremity runoff. Cannulation of left radial artery using # 6 French slender sheath. Placement of a pigtail catheter in the abdominal aorta and performance of the left lower extremity runoff. Percutaneous transluminal angioplasty and intravascular stent placement in the left common iliac and external iliac artery. Selective left lower extremity angiography. Placement of a terumo band for closure of the left radial artery." What do you suggest we code? 

Is this coded correctly? Can code 36246-XU be reported in this scenario? 75710 59, 37252, 37253 x 3, 37226, 37221, 37222. "1 U/S guide cannulation RT C Femoral A 2 Aortoiliac angiogram 3 LT LE angiogram 4 IVUS pre/post LT C ext. Iliac, c femoral, sfa, popliteal, tpt trunk arteries 5 angioplasty lt sfa 6 stent lt sfa and popliteal 7 stent lt c iliac 8 angioplasty lt external iliac PROC: RT C Femoral A cannulated, sheath placed, cath positioned in infrarenal aorta and aortoiliac angiogram done...stenosis in C Iliac A and bifurcation. Up and over technique, cath positioned in LT C femoral A. LT LE angiogram done. Occluded SFA and Popliteal w. fx stent in P SFA. 1 vessel runoff. Heparinized. Quick cross and wire traversed occluded stents and reenter TPT trunk. angiography. Emboshield. Balloon angioplasty SFA and popliteal. both IVUS. stenosis along SFA. Both Stented and angioplasty. IVUS C. Femoral A, stenosis. Stent and angioplasty to C. Iliac A. Balloon angioplasty entire external Iliac A. IVUS E Iliac A."

How would I code for placement of bilateral internal iliac angioplasty non-inflated balloon catheters in preparation for C-section (possible focal placenta accreta), with possible inflation later by OB physician? Contrast and fluoroscopy were utilized.

I am unsure whether the cath for the right side for the angiogram would be billable. There was intervention on both the right and left sides, but it was through the left access. "The decision to intervene was based on today's study, and there were no prior cath based studies to compare. Percutaneous 5 French RIGHT common femoral artery access. Cannulation of abdominal aorta. Pelvic arteriogram. Percutaneous 6 French LEFT common femoral artery access. 6 mm balloon angioplasty of the LEFT external iliac artery. Cannulation of RIGHT common iliac artery. Recanalization of chronically occluded RIGHT internal iliac artery. Primary balloon angioplasty to 4 mm of the origin of the RIGHT internal iliac artery."

Our surgeon attempted to perform a FEVAR on the patient, but, due to graft rotation and multiple attempts to salvage the orientation, it was unsuccessful. Catheters were selectively placed into the renals, and bilateral renal angioplasty was done prior to FEVAR attempt. He then converted to open repair of AAA and assoc. iliac artery occlusive dz with aortobifemoral bypass (18 x 9 bifurcated Dacron graft). Cutdown on both groins over femoral arteries. Explant of proximal body of a Cook Zenith fenestrated graft. Open repair ensued of above stated procedure." Please tell me how you would code this.

"Patient with left leg DVT with CT showing May-Thurner syndrome. Accessing the left popliteal vein a venogram was performed. The thrombosed portion of the left lower extremity was recanalized in the femoral, external iliac, and common iliac vein. Thrombosis throughout all these veins. Catheter to the IVC with an Inferior Cava venogram demonstrated no caval thrombus. AngioJet thrombectomy in the left leg with tPA performed. After swelling time of 20 minutes AngioJet again. Good results to the origin of femoral vein but partial occlusive thrombus in CFV and common iliac without inflow from profunda or internal iliac. So an infusion catheter overnight to be placed. However, since the flow was completely stagnant and there is only a mild amount of thrombus inline, we decided to perform angioplasty, as the risk of PE would be low and we wanted to have some flow through this segment, preventing re-thrombus. Angioplasty of left common iliac vein. Infusion catheter placed from prox fem through com iliac vein. Then infusion catheter placed." Would you report codes 36010, 75820-59-LT, 75825-59, 37187, and 37212-59?

"Emergent intraoperative vascular surgery consult. Ultrasound-guided retrograde access right common femoral artery. Intra-arterial angioplasty balloon inflation for temporary control arterial bleeding. Diagnostic right iliac and lower extremity angiogram. I-CAST covered stent repair of right external iliac artery injury. StarClose hemostasis right common femoral artery." Are codes 37244, 37236-51XE, and 36140-51XE appropriate for this?