Question Aortic Arch and extremities


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Hi can someone tell me what the cpts would be on this. A co-worker and I disagree, I feel it should be 36221, 36215, 36216, and 75822.


1. Percutaneous access of the right common femoral artery using real-time ultrasound guidance.
2. Ascending thoracic aortogram.
3. First order catheterization of the innominate artery.
4. Second order catheterization of the right subclavian artery.
5. First order catheterization of the left subclavian artery.
6. Bilateral upper extremity arteriogram.
7. Provocative testing with administration of vasodilator's and subsequent angiography.
8. Percutaneous closure device utilized for hemostasis.

After the procedure was explained and consent obtained, the patient was placed in a supine position on the fluoroscopy table. The right common femoral artery was localized using ultrasound guidance and locations marked. This region was prepped and draped
in the usual sterile fashion. The patient was numbed with 1% lidocaine solution. Access into the right common femoral artery was achieved with use of micropuncture set using ultrasound guidance. After a 5 French sheath was placed, a 0.035 guidewire was
placed within the thoracic aorta. A 5 French catheter was then placed within the descending thoracic aorta. Images were obtained of the arch vessels and aortic arch.

After this was done, selective catheterization of the right innominate and subclavian arteries were performed. Images of the right upper extremity were then obtained. Images of the hand were performed with and without vasodilators. After this was done,
the left subclavian artery was selectively catheterized. Images of this extremity were obtained including the hand. 75716 Images of the hand were also performed with without vasodilators.

A right common femoral arteriogram was performed. Hemostasis was achieved then with a closure device and manual compression. Sterile dressing was placed

Jim Pawloski

True Blue
Ann Arbor
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Your codes with modifiers should be 36221, 36215-LT, 36216-RT,59, 75716. 75822 is a bilateral Venogram, 75716 is a bilateral arteriogram.
Jim Pawloski, CIRCC