Intravascular lithotripsy is used alone or with stent placement to treat plaque in the arteries. Shockwave lithotripsy is a new technology that uses a traditional balloon catheter with multiple mounted emitters to provide pulsatile sonic energy to fragment calcified calcifications within the vessels. The procedure is performed by delivering an intravascular lithotripsy (IVL) catheter across a calcified lesion over a wire and the integrated balloon is expanded. An electrical discharge from the emitters vaporizes the fluid within the balloon, creating a rapidly expanding and collapsing bubble that generates sonic pressure waves. The waves travel through soft vascular tissue, selectively cracking vessel wall intimal and medial calcium.
The patient presented with stenosis of the right external iliac and common femoral arteries and underwent a percutaneous transluminal angioplasty (PTA) with shockwave lithotripsy therapy. During the procedure, a shockwave lithotripsy balloon was inserted and two treatments of shockwaves were delivered. A drug-coated balloon was then inserted and left in place for three minutes. Final angiography revealed excellent results and reduction in stenosis. How is shockwave lithotripsy therapy and drug-coated balloon angioplasty of the external iliac and common femoral arteries coded?
Assign the following ICD-10-PCS codes for the angioplasty with shockwave lithotripsy therapy of the right external iliac and common femoral arteries:
A patient was admitted for transfemoral aortic valve replacement (TAVR); however, due to horseshoe calcification at the right common iliac ostium, an intravascular lithotripsy was performed prior to the TAVR to treat the patient’s peripheral arterial disease and to allow for sheath placement necessary for the TAVR procedure. During the lithotripsy, a balloon was advanced across the lesion and inflated to a maximum of four atmospheres and 120 pulses were delivered. The balloon was then withdrawn to the origin of the external iliac and 60 additional pulses were delivered. Follow-up angiography revealed an excellent angiographic result without dissection. How is shockwave lithotripsy therapy of the right common and external iliac arteries coded?
Assign the following ICD-10-PCS codes for the intravascular shockwave lithotripsy of the right common and external iliac arteries:
The objective of the procedure is to break up the arterial calcifications. While the procedure involves a balloon, the purpose of the balloon is to facilitate the energy (pulse) transfer. Dilation codes are not assigned since there was no mention of “dilating the vessel” (or specifically performing a percutaneous transluminal angioplasty). Assign separate codes for the TAVR.