Abdominal Aortogram w/bilat runoff and coronary angio

jewlz0879

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I need some help. It is the physician's dictation that I'm having a hard time following because it is not very clear and concise.

How it was billed:
93454 -26
36246
75625-26
75716-26
75774-26

The documentation is not clear to me to bill CPT 36246 or 75774. I also see a thoracic aortogram that was not billed CPT 75605-26. I am rusty on these as I have not coded for them in a while. I need another set of eyes.

PROCEDURES PERFORMED:
1. Selective coronary angiography.
2. Thoracic aortogram.
3. Abdominal aortogram with bilateral runoff.
4. Bilateral selective angiograms of the lower extremities with runoff.

PROCEDURE IN DETAIL: We used a micropuncture kit to obtain left CFA access and a 6-French arterial sheath was placed. Aorta was noted to be very tortuous and so an abdominal aortic angiogram was going to be performed first; however, the pigtail did select the right iliac system and so we took this opportunity to take selective angiograms of the right lower extremity with runoff. Abdominal aortic angiogram was performed with runoff focusing on the left lower extremity. Thoracic aortic angiogram was performed showing a highly tortuous thoracic aorta. When then used a 6-French JL4 diagnostic catheter to take selective coronary angiograms and then used a JR4 diagnostic catheter to take an angiogram of the RCA. Attempted to obtain left ventricular access with the pigtail catheter and then just a J-wire and a JR4 diagnostic catheter. However, the pigtail would not cross the aortic valve due to tortuosity. Next, another aortic angiogram was performed with DSA of the iliacs. We then performed a more selective angiogram of the left lower extremity as well as DSA of the left lower extremity and the left CFA arterial access site was closed.

I thought to bill CPT 36246 there needs to be documentation of which artery was selectively catheterized? Same for CPT 75774. Is that right or wrong?

Plus the initial access was on the left CFA, if he went to the right, he would have to go down the Profunda Fem or popliteal for CPT 36246.

I appreciate any input.
 

Jim Pawloski

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I don't see any documentation of the coronaries were performed, unless you didn't give us that info. By this I would not code 93454, Catheter is in the rt iliac, so 36245-RT, no documentation of the aorta, so no 75625, and no documentation of a catheter going down the rt leg, so I would not code 75774. Code 75605 for the Thoracic aortogram.

HTH,
Jim Pawloski, CIRCC
 

jewlz0879

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I don't see any documentation of the coronaries were performed, unless you didn't give us that info. By this I would not code 93454, Catheter is in the rt iliac, so 36245-RT, no documentation of the aorta, so no 75625, and no documentation of a catheter going down the rt leg, so I would not code 75774. Code 75605 for the Thoracic aortogram.

HTH,
Jim Pawloski, CIRCC
Thanks so much, Jim!

Here is the Abdominal aortic angio with run-off and the coronary angio.
"Abdominal aortic angiogram was performed with runoff focusing on the left lower extremity. Thoracic aortic angiogram was performed showing a highly tortuous thoracic aorta. We then used a 6-French JL4 diagnostic catheter to take selective coronary angiograms and then used a JR4 diagnostic catheter to take an angiogram of the RCA. Attempted to obtain left ventricular access with the pigtail catheter and then just a J-wire and a JR4 diagnostic catheter. However, the pigtail would not cross the aortic valve due to tortuosity."

Quick question: would it still be CPT 36245 for the rt. iliac if he started on the left in the CFA? I'm used to physicians starting on the right and crossing over to the left and I thought starting from the left, crossing to the right, changed the code selection.
 
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