Wiki 36246 or 36247 and 75774?

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aunderhill

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Hello everyone, I need some help abstracting this op report. I am new to peripheral coding and am struggling. Any help is appreciated. Thank you

The codes I have come up with are:

36246 or 36247 – the reason I debate this is that I think only the wire went into the right superficial femoral artery and not the cath.

75625,26

75616,26

75774,26 tibioperoneal / foot – If this is correct, why is this not part of the lower extremity code. Does lower extremity not run the whole length of the limb?

99152 – do we get credit even though we called in anesthesiologist after, due to patient inability to stay still.


PROCEDURES PERFORMED:
1. Ultrasound-guided access to the left common femoral artery
2. Aortoiliac angiography
3. Bilateral selective lower extremity angiography
4. Deployment of a 6 French Perclose hemostatic closure device through the left common femoral artery.
SEDATION: Conscious sedation was provided by a trained nurse with intravenous boluses of fentanyl and Versed for a total of 45 minutes.
General anesthesia was needed because of inability to stay still for angiography. Therefore we called anesthesiologist on-call and general anesthesia was provided by Dr. Chu thereafter to perform the lower extremity angiogram


CLINICAL HISTORY:

61 year old man with history of hypertension, hepatitis C, ESRD, aortic stenosis, peripheral arterial disease, TIA and AF. He has bilateral lower extremity critical limb ischemia on the right foot with necrotic digits and bilateral nonhealing heel ulcers. He was referred for bilateral lower extremity angiography and possible intervention to improve the chance of healing and allow for transmetatarsal amputation of the right foot and eventually aortic valve replacement after lower extremity necrotic and infected tissue is removed.
TECHNIQUE: After explaining the risks and benefits of the procedure, informed consent was obtained, the patient was brought to the cardiac catheterization laboratory, prepared and draped in the usual sterile fashion. A 1% lidocaine solution was used to anesthetize the left groin area. Access to the left common femoral artery was obtained by using ultrasound and fluoroscopic guidance with a micropuncture set, then a 5 French 10 cm sheath was advanced over 0.035 wire. A 5 French rim catheter with side-hole was used to perform aortoiliac angiography with digital subtraction. Subsequently the right common iliac artery was selectively engage with the rim catheter and a 0.035 angled Terumo wire was advanced to the right common femoral artery and right lower extremity femoral-popliteal angiography was performed. Subsequently the 0.035 wire was advanced to the mid distal right superficial femoral artery and digital subtraction angiography of the tibioperoneal vessels and the foot was performed. The catheter was removed over a wire. Then from the Side-arm of the left common femoral sheath left lower extremity angiography was performed. The catheter was removed over a wire. The left common femoral artery angiography in the LAO projection demonstrated that the artery was appropriate for hemostatic closure device and a 6 French Perclose hemostatic closure device was successfully deployed. The groin was dressed in the usual sterile fashion and the patient was transferred to the recovery area in stable condition.
AORTOILIAC ANGIOGRAPHY:
The infrarenal abdominal aorta is normal size with mild calcification and no evidence of aneurysm or arterial obstructive disease.
Bilateral common iliac arteries are widely patent without significant obstructive disease.
Bilateral internal iliac arteries are widely patent without significant obstructive disease.
Bilateral external iliac arteries are widely patent without significant obstructive disease.
RIGHT LOWER EXTREMITY ANGIOGRAPHY:
The right common femoral artery is mildly calcified without significant obstructive disease.
The right femoral profunda is widely patent without significant obstructive disease.
The right superficial femoral artery is patent with diffuse calcification and luminal irregularities.
The right popliteal artery is widely patent with moderate calcification and luminal irregularities.
The right anterior tibial artery is patent with diffuse luminal irregularities and moderate calcification is the main vessel runoff to the foot and provides the dorsalis pedis and the dorsal arch to the foot.
The tibioperoneal trunk is patent without significant obstructive disease.
The right posterior tibial artery is severely calcified with moderate disease in the proximal segment, mid 90% stenosis with severe calcification, and distal 95% stenosis. The right posterior tibial artery provides in the distal segment a collateral network that provides flow to the heel.
The right peroneal artery is severely diffusely diseased with a mid chronic total occlusion and reconstitution of flow and distal 80% stenosis.
At the level of the foot the right anterolateral artery is the main vessel runoff. There is evidence of moderate diffuse metatarsal disease.
LEFT LOWER EXTREMITY ANGIOGRAPHY:
The left common femoral artery is widely patent without significant obstructive disease.
The left femoral profunda is widely patent without significant obstructive disease.
The left superficial femoral artery is widely patent with diffuse calcification and luminal irregularities.
The left popliteal artery is moderately calcified with a distal 60% stenosis.
The left anterior tibial artery is patent, is the main vessel runoff to the foot and has a 99% stenosis in the distal segment. The left anterior tibial artery provides flow to the dorsalis pedis and metatarsal arteries which have mild to moderate diffuse disease.
The left posterior tibial and peroneal arteries are totally occluded.
The main runoff to the foot is the left anterior femoral artery.
DIAGNOSTIC CONCLUSIONS:

1. Left obstructive popliteal artery disease
2. Severe bilateral occlusive tibioperoneal arterial disease..
 
I would not code the abdominal aorta since a complete exam is not supported. And I would not code 75774 as again it is not supported. For Catheter placement, code 36246. Last thing, code 75716 for the extremity arteriogram, bilateral.
HTH
 
Jim Pawloski said:
I would not code the abdominal aorta since a complete exam is not supported. And I would not code 75774 as again it is not supported. For Catheter placement, code 36246. Last thing, code 75716 for the extremity arteriogram, bilateral.
HTH
Click to expand...
Thank you so much for your reply Jim, I really appreciate it! For knowledge of future claims, what verbiage or process would have to be done during the encounter?
Does the 75625,26 not count because the catheter did not go into the aorta?
When the doctor stated that the wire was advanced to the mid distal right superficial femoral artery and digital subtraction angiography of the tibioperoneal vessels and the foot was performed," what would the doctor have had to have done procedure wise to qualify for a 75774? I was under the impression that when the wire moved lower and another angiography is completed that it was in addition to the 75716 and therefor could be coded. Thanks again this is a learning curve!
 
Okay, first thing is you don't code where the wire went, you code where the catheter went. So in using your example, after the imaging from the SFA, "the catheter was advanced into the anterior tibial artery and an arteriogram was performed to see the distal aspect of the artery. As for the abdominal aorta, I code 75625 when the renal arteries are documented. If the catheter is placed in the distal aorta, and a arteriogram is performed, that is part of the extremity arteriogram (75710 or 75716).
 
Jim Pawloski said:
Okay, first thing is you don't code where the wire went, you code where the catheter went. So in using your example, after the imaging from the SFA, "the catheter was advanced into the anterior tibial artery and an arteriogram was performed to see the distal aspect of the artery. As for the abdominal aorta, I code 75625 when the renal arteries are documented. If the catheter is placed in the distal aorta, and a arteriogram is performed, that is part of the extremity arteriogram (75710 or 75716).
Click to expand...
Thank you so much Jim! Your knowledge is appreciated!
 
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