Carotids - Not Bovine

jewlz0879

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These always give me fits when the catheter starts moving all over...when they selectively cannulate different vessels off the same branch; that's when I get lost.

Scenario 1: RFA cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then advanced into the left internal carotid artery and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then withdrawn and advanced to the right common carotid to selectively cannulate and angiography completed.

Codes:
LCCA: 36215
LICA: 36216
Left Vertebral: 36216, 59
RCCA: 36216, 59
75680
75665
75685

Do I need to change my LICA 36216 to 36218? That's where I get confused. Understanding WHEN to do that. I really want to get this! LOL.

Scenario 2: RFA cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then withdrawn and advanced to the right common carotid where it's selectively cannulated and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then moved down to selectively cannulate the left subclavian and angiography completed.

What if he then went all the way to the right and selectively cannulated the right subclavian as well with angiography?

Codes:
LCCA: 36215
RCCA: 36216
Left Vertebral: 36216, 59 (or would I change this?)
Left Subclavian: 36215,59

With
Right Subclavian, 36218,59?

Thank you in advance to anyone who can help me better understand this! :)
 

dpeoples

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these always give me fits when the catheter starts moving all over...when they selectively cannulate different vessels off the same branch; that's when i get lost.

scenario 1: Rfa cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then advanced into the left internal carotid artery and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then withdrawn and advanced to the right common carotid to selectively cannulate and angiography completed.

Codes:
Lcca: 36215
lica: 36216
left vertebral: 36216, 59
rcca: 36216, 59
75680
75665
75685

do i need to change my lica 36216 to 36218? That's where i get confused. Understanding when to do that. I really want to get this! Lol.

scenario 2: Rfa cannulated catheter moved up into aortic arch then under fluoroscpic guidance the catheter was advanced into the left common carotid and angiography is performed. Catheter was then withdrawn and advanced to the right common carotid where it's selectively cannulated and angiography completed. The catheter was withdrawn and then advanced to the left vertebral where it was selectively placed and angiography completed. Catheter was then moved down to selectively cannulate the left subclavian and angiography completed.

What if he then went all the way to the right and selectively cannulated the right subclavian as well with angiography?

Codes:
Lcca: 36215
rcca: 36216
left vertebral: 36216, 59 (or would i change this?)
left subclavian: 36215,59

with
right subclavian, 36218,59?

thank you in advance to anyone who can help me better understand this! :)
1) Assuming normal anatomy, there are 3 different vascular families selected in this document, the lt carotid, lt subclavian/vertebral, rt carotid. Each should be coded to the highest order selected, plus any additional 2nd or 3rd order vessels selected in that vascular family.
Also, the 1st order vessels are always part of higher order selection within the same vascular family. So, you have 36216 lica, 36216-59 rcca, 36216-59 lt vert

2) Again, assuming normal anatomy, the selection of the lt subclavian in included (passed through) with the selection of the lt vert, just code 36216, and drop 36215. If he selects the rt subclavian that is an additional higher order vessel in the same vascular family with the rt carotids. You would then code 36218.

I will say that all of these need to be reflected in the medical necessity. For instance, what was the purpose of selecting the lt subclavian artery after having already selected (and presumably imaged) the lt vert? Perhaps that was a typo and the rt subclavian was actually seleted to image the rt vert (a typical 4 vessel study). You should verify this with the provider if possible.

If you code these often , a good chart/ diagram is invaluable. Dr Z products are excellent.

hth :)
 
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jewlz0879

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Thank you Danny; I just had an "ah-ha" moment. I do have the Dr. Z diagrams but I've just always struggled with Carotids unless they are cut-n-dry, for the most part. I could not for the life of me figure out when I needed to change the cath code to reflect additional higher order vessel; I knew there were times it had to be done, just couldn't quite put my finger on it. I can now!

I do need to speak with this physician about his reflected m.n. He's a new physician within our group and a lot of his stuff is being denied because of the coding, so I am reviewing it - these are a couple of cases I came across but wasn't sure if they were billed correctly and, obviously, they were not.

Thanks so much for your help and expertise!
 
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