Abdominal aortogram

[OPENSHAW]

Help!
Our Cardiologist did the following?

Aortogram with bilateral runoffs.
Abdominal aortogram.
Selective left femoral arteriogram.
Selective right femoral arteriogram.
Angio-Seal closure of the arteriotomy.

I am not sure how to code this? I am new in this field. Thank you!

[Cyndi113]

please post the procedure note

[OPENSHAW]

I need help, please, in coding this!

Surgery date: 06/18/2012

1. Aortogram with bilateral runoffs
2. Abdominal aortogram.
3. Selective left femoral arteriogram.
4. Selective right femoral arteriogram.
5. Angio-seal closure of the arteriotomy.

reason for the procedure: The pt. Has long history of coronary artery disease. Most recently had neen having significant leg pain with exertion. Claudication that occurred approximately after one block mostly on the left side and was also occurring on the right side, and so it was decided to proceed with an aortogram and a distal selective iliac arteriogram with distal followthrough.

hemodynamic findings: Blood pressure was 150/73 and the left femoral artery was 147/66.

angiographic findings: The patient was taken to the tca catheterization laboratory in a postprandial state. His right groin was cleaned and draped in the usual manner and anesthetized with 20 cc of 2% xylocaine. Femoral artery was easily cannulated and a #5 sheath was positioned in it. The abdominal aortogram was performed in dsa and this showed nonocclusive disease in the aorta and both renal arteries were patent. A second abdominal aortogram with bilateral runoffs was performed. The right superficial femoral exhibited a 90% stenosis in the mid portion. Also, on the right side, the posterior tibial and the peroneal were 100% occluded. On the left side, there was a 90% occlusion of the mid portion of the superficial femoral and the popliteal was 100% occluded and the reconstitution was into the anterior tibial and the peroneal. The posterior tibial was 100% occluded. There was another selective femoral arteriogram performed behind the patient has a left femoral head. The patient had a hip surgery with a left femoral head replacement and therefore left femoral arteriogram was performed because that area was not seen in the abdominal aortogram with runoffs in the ap projection; however, in the rao projection, the selective arteriogram of the left femoral arteriogram showed nonocclusive disease in the area behind the femoral head. A right femoral angiogram was performed to evaluate for closure device placement. Angio-seal was done to close the arteriotomy. The patient tolerated the procedure well.

plan: Most likely roto-ablation with balloon of the both superficial femorals and possibly of the left popliteal.

[Jim Pawloski]

Originally Posted by OPENSHAW

I need help, please, in coding this!

Surgery date: 06/18/2012

1. Aortogram with bilateral runoffs
2. Abdominal aortogram.
3. Selective left femoral arteriogram.
4. Selective right femoral arteriogram.
5. Angio-seal closure of the arteriotomy.

reason for the procedure: The pt. Has long history of coronary artery disease. Most recently had neen having significant leg pain with exertion. Claudication that occurred approximately after one block mostly on the left side and was also occurring on the right side, and so it was decided to proceed with an aortogram and a distal selective iliac arteriogram with distal followthrough.

hemodynamic findings: Blood pressure was 150/73 and the left femoral artery was 147/66.

angiographic findings: The patient was taken to the tca catheterization laboratory in a postprandial state. His right groin was cleaned and draped in the usual manner and anesthetized with 20 cc of 2% xylocaine. Femoral artery was easily cannulated and a #5 sheath was positioned in it. The abdominal aortogram was performed in dsa and this showed nonocclusive disease in the aorta and both renal arteries were patent. A second abdominal aortogram with bilateral runoffs was performed. The right superficial femoral exhibited a 90% stenosis in the mid portion. Also, on the right side, the posterior tibial and the peroneal were 100% occluded. On the left side, there was a 90% occlusion of the mid portion of the superficial femoral and the popliteal was 100% occluded and the reconstitution was into the anterior tibial and the peroneal. The posterior tibial was 100% occluded. There was another selective femoral arteriogram performed behind the patient has a left femoral head. The patient had a hip surgery with a left femoral head replacement and therefore left femoral arteriogram was performed because that area was not seen in the abdominal aortogram with runoffs in the ap projection; however, in the rao projection, the selective arteriogram of the left femoral arteriogram showed nonocclusive disease in the area behind the femoral head. A right femoral angiogram was performed to evaluate for closure device placement. Angio-seal was done to close the arteriotomy. The patient tolerated the procedure well.

plan: Most likely roto-ablation with balloon of the both superficial femorals and possibly of the left popliteal.

You have 36200, 75625, and 75716. There is no mention of catheter movement, so I would nnot bill a selective catheter placement or additional angio. after the basic.
HTH,
Jim Pawloski, CIRCC, R.T. (CV)

[Robbin109]

I'm confused as to why this wouldn't be coded as 75630( abd aortography with bil iliofemoral runoff)

I've been studing peripheral angio recently and this exact same scenerio has me scratching my head.

[Jim Pawloski]

Originally Posted by Robbin109

I'm confused as to why this wouldn't be coded as 75630( abd aortography with bil iliofemoral runoff)

I've been studing peripheral angio recently and this exact same scenerio has me scratching my head.

I may have over-read this. The doc states a "a second aortagram w/ bolus chase was performed". I would assume that the catheter was moved because why would you look at the same area twice, and overload the kidneys with contrast (that's the x-ray technologist in me)? But he does not say the catheter was moved, so I would code 75630 and not 75625 and 75716 because of the non catheter movement. Sorry about the confusion.
HTH,
Jim Pawloski, CIRCC, R.T.(CV)

[Robbin109]

Sorry Jim, I was trying to understand this code set in general...so it looks like if he only injects once without moving the cath and comments on abd aorta and bil run-off, then you use 75630? But if he moves the catheter down to the bifuracation and injects again you would code 75625 and 75616....??

Thanks?!

[Robbin109]

Sorry Jim, I was trying to understand this code set in general...so it looks like if he only injects once without moving the cath and comments on abd aorta and bil run-off, then you use 75630? But if he moves the catheter down to the bifuracation and injects again you would code 75625 and 75716....??

Thanks?!

[Jim Pawloski]

Originally Posted by Robbin109

Sorry Jim, I was trying to understand this code set in general...so it looks like if he only injects once without moving the cath and comments on abd aorta and bil run-off, then you use 75630? But if he moves the catheter down to the bifuracation and injects again you would code 75625 and 75716....??

Thanks?!

That is correct. Have a great day!
Jim