Ask Dr. Z

Hi Dr. Z and Dr. Dunn,I have a combined procedure between surgeon and interventional radiologist for bilateral popliteal aneurysms with endartarectomy on one side. I'm unsure as to whether this is coded as open stent placements, popliteal aneurysm repair or exclusion of the aneurysm which leads me to an embolization code. The surgeon exposed the arteries via cutdown so I'm clear on this being an open procedure. The dictation describes the following: Access to the common femoral arteries was provided by the vascular surgeon, who performed bilateral cut-downs. Single-wall needles were utilized to access the common femoral arteries bilaterally directed in an antegrade fashion. Eventually vascular sheaths were advanced into the proximal superficial femoral arteries and bilateral selective angiography was performed, confirming large bilateral popliteal aneurysms (right greater than left). Additionally, there is severe stenotic disease noted in the left superficial femoral artery. Utilizing 0.035 Glidewires, 5-French catheters were advanced into the distal popliteal arteries and over 0.035 guidewires, overlapping Viabann stents were deployed at the site of the aneurysm and post-dilated using 7mm angioplasty balloons. Completion angiography demonstrated excellent exclusion of the aneurysms with preserved distal flow bilaterally. The vascular surgeon now picks up the dictation and continues: Upon completion of the endo-stenting angiograms sluggish flow to the right side was demonstrated. The superficial femoral artery on the righ had very weak pulsation. It was noticed to be due to a large plaque in the common femoral, which was partially lifted during the previous procedure. The arteriotomy was extended and a large plaque removed from the base of the common femoral and into the entrance of the profunda femoral. A patch was needed in order to establish a better flow in to the superficials and this was done with an Impra patch. The surgeon goes on to describe repair and closure of the groins. What I'm most concerned with is the IR portion of the stent placements. I initially coded as 37207/75960 and 37208/75960 X2 for the two popliteals, then saw the implant documentation indicated for all four stents as Right SFA, Left SFA, Right Popliteal and Left popliteal. I'm hesitant to code the SFA as additional vessels for stent placement since I don't have documentation of why the stents were extended into that vessel. The encoder software wants to code this as an exclusion of the aneurysm cpt 37204. I have never used the popliteal aneurysm 35151 code so not sure this is the right code either or if that requires excision of the aneurysm. I am not coding any angiography as he states this was only to confirm the aneurysm. Catheter placements from common fem to popliteal antegrade I believe would be 36246 on both sides. Any help is greatly appreciated.