Wiki Bovine arch - please help

[jewlz0879]

RFA access. Pigtail cath tracked into the aortic arch where an arch aortogram was done which demonstrated a type 1-2 bovine arch of the LCCA. Pigtail was exchanged and tracked up into the left subclavian into the ostium of the Left vertebral and injection was done. Catheter repositioned into the RCCA and injection was done. Catheter repositioned in Right vertebral artery and injection done. Cath then repositioned into the LCCA and a 2nd order injection was done.

The bovine arch really confuses me. I'm not confident of my code selection at all and I can't find any awesome resouces that explain how to choose codes when he does it like this. I'm sure I'm off but this is what I get:

Lt Vertebral - 36216/75685-26,LT
Rt CCA - 36217
Rt Vertebral - This is where I get confused - do I use 36217-59?
Lt CCA - 36218

75680 - 26
75685 - 26, RT
75685 - 26, LT
75650 - 26

Please help!

Any tips or information about the bovine arch is very much appreciated!

 

[Kssleighton]

bovine arch

The right vertebral would be 36218 since it shares the innominate or brachiocephalic origin. I would probably do the rcca as 36218 and the rvert as 36217. It doesn't make much difference but the rvert code is higher rvu than the rcca.
As for good coding tools, I use the Medlearn vessel charts, but my favorite is and old 2006 chart by medical asset management. I attended an interventional radiology seminar by Medlearn. It was excellent!
Hope this helps.