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My question on the case that follows is regarding the unsuccessful recanalization of the SFA with a Crosser catheter. The physician was able to pass the Crosser catheter through the occlusion of the SFA, but was not able to proceed with any other interventions due to not be in the true lumen. Based on the documentation in the operative note below, would code 37225 be reportable?

Operative report: PROCEDURES PERFORMED: 1. Abdominal aortogram. 2. Right lower extremity distal runoff, third order catheter placement. 3. Percutaneous transluminal angioplasty and stent placement, right external iliac artery. 4. Crosser atherectomy, right superficial femoral and popliteal artery. INDICATIONS: Woman who presented to the office with ischemic rest pain of the right lower extremity. Physical examination as well as noninvasive studies confirmed the atherosclerotic etiology, and she is, therefore, undergoing angiography with hope for intervention and limb salvage. PROCEDURE: The patient is taken to the Special Procedures Suite and placed in the supine position. After adequate sedation is achieved, both groins are prepped and draped in a sterile fashion. 1% lidocaine is infiltrated in the soft tissues overlying the left common femoral impulse, and access to the left common femoral artery is obtained with ultrasound guidance. Ultrasound is placed in a sterile sleeve. Ultrasound is utilized secondary to lack of appropriate landmarks to avoid vascular injury. Under direct visualization, the common femoral artery is identified. Image is recorded for the permanent record. The artery is noted to be pulsatile and homogeneous indicating patency. Micropuncture needle is inserted into the anterior wall with direct ultrasound visualization. Microwire followed by micro sheath, J-wire followed by 5 French sheath and 5 French pigtail catheter are then inserted. Pigtail catheter is positioned at the level of T12, and AP projection of the abdominal aorta is obtained. Pigtail catheter is repositioned to above the bifurcation, and an LAO projection of the pelvis is obtained. Previously placed stents in the common iliac arteries are identified, and both are patent. Occlusion of the right external iliac artery is identified with reconstitution of the common femoral. 5000 units of heparin is given and using a combination of VS-1 rim, and the pigtail catheter and a stiff angled Glidewire the aortic bifurcation is crossed. Initially the VS-1 is successful. The Glidewire and VS-1 catheter are then negotiated across the external iliac and into the common femoral artery. Hand injection of contrast demonstrates patency of the common femoral and intraluminal placement. The catheter is then advanced into the profunda femoris, and the 5 French sheath is exchanged for a 7 French Balkan sheath. Balkan sheath is positioned in the mid common iliac on the right, and a 6 x 10 Rival balloon is used to angioplasty the external iliac artery. Follow-up angiography demonstrates it is patent. There is a significant intimal flap; however, this does allow advancing the Balkan in so that the tip is now in the common femoral. Additional heparin is given. The S6 crosser with an angled Usher catheter is then positioned at the small cul-de-sac, and Crosser catheter is used to advance down to the popliteal. Ultimately, however, we were not able to re-enter the true lumen in the mid popliteal, and further attempts at treating the SFA were abandoned. The Crosser catheter and Usher catheter were then removed. There was an exchange for a 0.035 Magic torque wire, and a Life Star 7 x 80 stent was deployed across the external posted with a 6 mm balloon. Follow-up angiography demonstrated the iliac system is now widely patent flowing into a common femoral and profunda femoris, which were widely patent. The sheath was then pulled into the external iliac on the left side, oblique view obtained, and subsequently the sheath was exchanged for a 7 French 11 cm sheath. ACT was checked, which was noted to be 200, and the sheath was later then pulled and pressure held. There were no immediate complications. INTERPRETATION: Initial views of the abdominal aorta demonstrate diffuse atherosclerotic changes. However, there are no hemodynamically significant stenoses. The aortic bifurcation is diseased but patent. There are bilateral common iliac artery stents. They do not extend up into the aorta. They are both patent. The right external iliac artery appears occluded. Internal iliac artery is patent. There is reconstitution of the common femoral and profunda femoris. Superficial femoral artery is a flush occlusion. The popliteal is reconstituted in its midportion at the level of the femoral condyles, and there appears to be single vessel runoff to the foot. Following angioplasty there is a flow-limiting dissection in the external iliac. This was later treated effectively with a Life Star stent and postdilated to 6 mm. Attempts at crossing the SFA using a crosser atherectomy catheter were successful at achieving the catheter and negotiating down into the popliteal; however, we could not re-enter the true lumen and, therefore, no further interventions were performed at this time. SUMMARY: 1. Successful recanalization of the iliac system. 2. Unsuccessful recanalization of the SFA.