Ask Dr. Z

For the following example, we are not sure about the correct CPT code for retrograde catheter placement? 36246? "The right groin and right foot were prepped and draped in the usual fashion. Under ultrasound guidance the distal anterior tibial artery at the level of the ankle was accessed with a micropuncture needle. Images were saved for further review of the medical records. A 2.9 French sheath was advanced into the artery and arteriogram was obtained to confirm the intraluminal placement of the sheath. Next 200 mcg of nitroglycerin were administered through the sheath. Next a Cook wire was advanced with the help of the 0.18 CXI catheter to the level of the occluded SFA. Next different wires were utilized including a 0.018 wire, then a 25 g CTO Cook wire and all these wires were unable to cross the lesion despite the support catheter. Next I tried a 0.018 Glidewire to try to obtain a subintimal plane and that also was not possible. We proceeded to pull wires and catheters the micro sheath and manual pressure was held for 10 minutes at the level of the ankle."