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Aortogram and iliac angiogram

MADDIE

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Would appreciate any input re: codes for the following:
Under ultrasound guidance, the left common femoral artery was entered with an 18 gauge needle and a J wire was placed into the aorta. We placed a 4-French sheath. We placed an ultra flush catheter to L1 over the wire. We shot an aortogram and iliac angiogram with obliquities. I then placed an angled glidewire and ultra flush catheter up and over the aortic bifurcation into the right common femoral artery. Here I shot a right lower extremity angiogram and "diagnosed" the SFA disease. We then gave 5000 heparin and I confirmed and ACT greater than 225. I crossed the lesion with a combination of an angled glidewire and quick cross catheter.I confirmed intraluminal position in the below-knee popliteal with an angiogram. I exchanged out for a versacore wire. I marked up the lesion and advanced a 6 mm diameter x 150mm length stent over the wire across the lesion and deployed the stent. I postdilated the stent. The was 0% residual stenosis on angiogram. I then shot an angiogram of the left extremity, that showed moderate SFA stenosis and 3 vessel runoff.
I'm thinking 37226, 75716/ 26, Not sure re: codes for an aortogram and iliac angiogram
If there was no intervention how would this be coded?
 

abegnaud

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Since there is no interpretation of the aortogram and iliac angiogram, nothing is codeable.

Also the extremity angiogram interp is vague. All it says was the SFA disease was "diagnosed" So I'm not sure if anything is codeable there either.
 

Bwray

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With a separate report or separate paragraph on the Operative Report, CPT 36246 for the catheterization, CPT 75625-26 for the aortogram and 75710-26 for the unilateral extremity. This can be coded with the revascularization code 37226 if;
1. No previous catheter-based angiogram is accessible and a complete diagnostic procedure is preformed and the decision to proceed with an interventional procedure is based on the diagnostic service, OR
2. The previous diagnostic angiogram is accessible but the documentation in the medical record specifies that:
A. the patient's condition has changed
B. there is insufficient imaging of the patient's anatomy and/or disease OR
C. there is a clinical change during the procedure that necessitates a new
examination away from the site of the intervention.
3. Modifier 59 is appended to the code(s) for the diagnostic radiological supervision and interpretation service to indicate the guidelines were met.
Ingenix CPT Expert book

Hope this helps,

Brenda
 
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