margaret fahy
Guru
Hi...
For angiographies below, dr. documents rt/lt main renals and then rt/lt accessory renals.
Would you code 36252, as the accessory renals are included in this? Dr. doesn't state order of vessels but does mention "branches" in findings....
What would you guys code?
Thanks so much.
PROCEDURE: The skin of the right groin was prepped and draped in
sterile fashion over the right common femoral artery. Using US
guidance a 21 gauge needle was inserted in the right common
femoral artery. Once arterial blood return was obtained a .018"
Nitrex wire was placed into the artery and advanced to the distal
abdominal aorta. The needle was removed and replaced with a 5
French micropuncture sheath/dilator set. The wire was sized up
to a .035" Newton wire, and a long angled 5 French vascular
sheath was placed into the artery. Via the arterial sheath a 5
French pigtail catheter was advanced into the mid abdominal aorta
and digital subtraction angiography was performed. The pigtail
catheter was removed and exchanged for a 5 French JB-1 catheter.
This catheter was manipulated until it was in the left main renal
artery and biplane DSA was performed in frontal projection and
multiple obliquities. The catheter was then manipulated into the
right main renal artery and DSA was performed in frontal
projection and multiple obliquity's. The catheter was removed
and exchanged for a 3 French JR1.5 catheter. This catheter was
manipulated until it was in the left accessory renal artery and
biplane DSA was performed in frontal and oblique projections.
The catheter was then manipulated into the right accessory renal
artery and DSA was performed in the frontal and oblique
projections. The catheter and sheath were then removed and
manual compression was applied until hemostasis was achieved. A
sterile occlusive dressing was applied at the site. There were
no complications and the patient left the IR Suite in stable
condition. Dr. was present for the entire procedure.
FINDINGS:
Aorta: The abdominal aorta is normal in course and caliber. The
celiac, superior mesenteric and inferior mesenteric arteries are
patent. The right and left main renal arteries are widely
patent. Single accessory renal arteries supply the lower poles
of each kidney.
Right Main Renal: The right main renal artery is patent. The
origin of the right renal artery is widely patent. The
intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Left Main Renal: The left main renal artery is patent. The
origin of the left renal artery is widely patent. The
intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Right Accessory Renal: The right accessory renal artery is
patent. The origin of the right accessory renal artery is widely
patent. The intraparenchymal arteries are normal in course and
caliber without focal narrowing or aneurysm.The cortical
perfusion and renal vein drainage is normal.
Left Accessory Renal: The left accessory renal artery is patent.
The origin of the left accessory renal artery is widely patent.
The intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Normal bilateral main renal arteries and intra-renal branches
without evidence of renal artery stenosis.
Normal bilateral accessory renal arteries and intra-renal
branches without evidence of renal artery stenosis.
Normal aortogram and abdomina branches.
Normal renal cortical size and perfusion.
For angiographies below, dr. documents rt/lt main renals and then rt/lt accessory renals.
Would you code 36252, as the accessory renals are included in this? Dr. doesn't state order of vessels but does mention "branches" in findings....
What would you guys code?
Thanks so much.
PROCEDURE: The skin of the right groin was prepped and draped in
sterile fashion over the right common femoral artery. Using US
guidance a 21 gauge needle was inserted in the right common
femoral artery. Once arterial blood return was obtained a .018"
Nitrex wire was placed into the artery and advanced to the distal
abdominal aorta. The needle was removed and replaced with a 5
French micropuncture sheath/dilator set. The wire was sized up
to a .035" Newton wire, and a long angled 5 French vascular
sheath was placed into the artery. Via the arterial sheath a 5
French pigtail catheter was advanced into the mid abdominal aorta
and digital subtraction angiography was performed. The pigtail
catheter was removed and exchanged for a 5 French JB-1 catheter.
This catheter was manipulated until it was in the left main renal
artery and biplane DSA was performed in frontal projection and
multiple obliquities. The catheter was then manipulated into the
right main renal artery and DSA was performed in frontal
projection and multiple obliquity's. The catheter was removed
and exchanged for a 3 French JR1.5 catheter. This catheter was
manipulated until it was in the left accessory renal artery and
biplane DSA was performed in frontal and oblique projections.
The catheter was then manipulated into the right accessory renal
artery and DSA was performed in the frontal and oblique
projections. The catheter and sheath were then removed and
manual compression was applied until hemostasis was achieved. A
sterile occlusive dressing was applied at the site. There were
no complications and the patient left the IR Suite in stable
condition. Dr. was present for the entire procedure.
FINDINGS:
Aorta: The abdominal aorta is normal in course and caliber. The
celiac, superior mesenteric and inferior mesenteric arteries are
patent. The right and left main renal arteries are widely
patent. Single accessory renal arteries supply the lower poles
of each kidney.
Right Main Renal: The right main renal artery is patent. The
origin of the right renal artery is widely patent. The
intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Left Main Renal: The left main renal artery is patent. The
origin of the left renal artery is widely patent. The
intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Right Accessory Renal: The right accessory renal artery is
patent. The origin of the right accessory renal artery is widely
patent. The intraparenchymal arteries are normal in course and
caliber without focal narrowing or aneurysm.The cortical
perfusion and renal vein drainage is normal.
Left Accessory Renal: The left accessory renal artery is patent.
The origin of the left accessory renal artery is widely patent.
The intraparenchymal arteries are normal in course and caliber
without focal narrowing or aneurysm. The cortical perfusion and
renal vein drainage is normal.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Normal bilateral main renal arteries and intra-renal branches
without evidence of renal artery stenosis.
Normal bilateral accessory renal arteries and intra-renal
branches without evidence of renal artery stenosis.
Normal aortogram and abdomina branches.
Normal renal cortical size and perfusion.