Abdominal aortagraph

zizdreli

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Can someone confirm if Im coding right? Or give any feedback. I feel the doctor maybe is not documenting enough? What do you guys think? Is it just me?

Consent was obtain. A 6 french sheath was inserted in the left common femoral artery via micropuncture technique through which left lower extremity angiography was performed. Aortgraphy was performed via a 5 french contra flush cathether. Right lower extremity angiography was performed via 5 french contra 2 cathether. At the end of the case a perclose device was deployed in the left common femoral artery. No complications.

I think 36200 75625 75716?

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Is it common to do an angio first on the side where the access is and then go up to aorta to do angio and proceed to other extremity and do angio there? Or do they usually do both angio extremity after contrast is injected at the bifurication? Everything i read describes it "that" way but when i read our op reports it seems our doctor does one angio before he even goes to the aorta.
 

Jim Pawloski

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You can do both. Usually, after sheath placement, the catheter is placed at the level of the renal arteries and the abdominal aorta is injected. Then the catheter is placed at the bifurcation and both extremities are imaged.
As to this case, the information is very limited. With this dictation, I would only code 36245-RT and 75716. There is no documentation of the renal arteries, so I would not code 75625. I am assuming ( which I should not do) that the rt common iliac artery was selected (needs to be defined), to code 36245-RT. Both lower extremities are imaged, so you are correct with 75716.
HTH,
Jim Pawloski, CIRCC
 
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zizdreli

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You can do both. Usually, after sheath placement, the catheter is placed at the level of the renal arteries and the abdominal aorta is injected. Then the catheter is placed at the bifurcation and both extremities are imaged.
As to this case, the information is very limited. With this dictation, I would only code 36245-RT and 75716. There is no documentation of the renal arteries, so I would not code 75625. I am assuming ( which I should not do) that the rt common iliac artery was selected (needs to be defined), to code 36245-RT. Both lower extremities are imaged, so you are correct with 758716.
HTH,
Jim Pawloski, CIRCC

Jim
By this sequence (where an angio is done on one extremity first and then he goes to do an angio in the aorta, then does an angio on the other extremity) is there any way in how this is documented that would indicate a 75630 abdominal runoff was done? The dr likes to code it that way along with just a 75710 (one sided only) and i just cant see it that way.
 

Jim Pawloski

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To quote Dr. Zielske, "Code 75630 requires imaging of the abdominal aorta, not just the distal most aspect of the aorta. The distal most portion of the aorta is incidentally and routinely seen when a pigtail catheter is injected at the level of the aortic bifurcation for the purpose of lower extremity angiography and is part of the code 75716." (Z health publishing, Diagnostic & Interventional Cardiovascular Coding Reference, Pg. 299, bullet no. 9)
 
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