Ask Dr. Z

I'm not sure what I should bill for the following:

INDICATIONS: This lady had a stent-assisted coil embolization of left cervical ICA. This is a follow-up angiogram. Benefits and risks were discussed in detail with the patient, including bleeding, femoral artery injury, loss of blood supply to the leg, loss of the leg, dissection of the aorta, stroke, TIA, and dissection of the carotid and benefits. The patient consented procedure and was brought to the operative room. DESCRIPTION OF OPERATION/PROCEDURE: The patient was brought to the operative room by the Neuro Anesthesia team. Monitored aesthetic care was induced in supine position. All the pressure points were padded appropriately. The groin was prepped and draped in the usual sterile fashion. Lidocaine was injected along the right groin crease. Skin knife was used to make 2 mm skin incision. Eighteen gauge needle and single wall technique was used to access the right common femoral artery. 5 French sheath was placed over the guidewire provided. Using 5 French Berenstein diagnostic catheter and Terumo 038, multiple coils vessels were imaged. FINDINGS: Right common femoral artery selective injection: The right common femoral artery was selected. The catheter was advanced in it. AP view showed the internal iliac artery, right common femoral artery, right superficial, and profunda femoral arteries to have normal caliber and branching. The puncture site was appropriate for Angio-Seal device deployment. Common iliac selective injection: The right common iliac was selected. The catheter was advanced in it. AP view showed there was a possible dissection of the common iliac artery. Thoracic aortic injection. Thoracic aortic injection. The catheter was kept in the thoracic aortic area. An injection was noted that there is a dissection. At that time, the patient was complaining of chest pain and we consulted the Vascular Surgery and Cardiothoracic. The patient was then intubated and a TEE was performed to ensure there was no dissection of the ascending aorta or the arch. Following that, the patient was transferred to the CT for obtaining a CT of the chest and abdomen. Also, we sent for labs to make sure there is no troponin increase or worsening of the creatinine. I applied manual compression for 15 minutes.