Cath-report Please confirm my code choices

coders_rock!

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Please confirm the codes I've chosen:37227[RT], 36247, 75716[26], 36200, 36140.
Are my choices correct, if not, please indicate why you disagree.

Thank you!

Vessel Angiography Findings

RIGHT LOWER EXTREMITY ANGIOGRMA:
-Moderate diffuse disease right external iliac and common femoral artery
-Severe diffuse disease of the SFA terminating in 100% occlusion distal SFA with reconstitution of the popliteal artery via collaterals from the profunda and geniculate arteries
-90% stenosis TPT trunk
-100% occlusion peroneal and PT arteries with reconstitution of the PT distally
-Moderate diffuse disease mid AT
-1 vessel run-off to the foot via the AT

LEFT LOWER EXTREMITY ANGIOGRAM:
-Moderated diffuse disease common femoral artery
-80% stenosis ostial SFA
-Widely patent self expanding stents seen in the mid and distal SFA
-80% calcified stenosis popliteal artery
-Below knee arteries not visualized in this study

Catheterization Procedure:
Access gained via the left common femoral artery and a 6F 70 cm Cook sheath was advanced to the level of the right common femoral artery. An Aquatrack wire was advanced through the distal SFA occlusion and exchanged for a Viper Wire. Elliptical artherectomy using 1.5 crown Diamondback device was performed in the popliteal, proximal mid and distal SFA followed by balloon angioplasty. Flow limiting dissection necessitated the placement of self expanding SMART stents measuring 7 x 150mm, 7 x 120 mm and 7 x 60mm from distal to proximal. The SFA was then dilated using 5mm and 6mm PTA balloons.
 

donnajrichmond

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Please confirm the codes I've chosen:37227[RT], 36247, 75716[26], 36200, 36140.
Are my choices correct, if not, please indicate why you disagree.

Thank you!

Vessel Angiography Findings

RIGHT LOWER EXTREMITY ANGIOGRMA:
-Moderate diffuse disease right external iliac and common femoral artery
-Severe diffuse disease of the SFA terminating in 100% occlusion distal SFA with reconstitution of the popliteal artery via collaterals from the profunda and geniculate arteries
-90% stenosis TPT trunk
-100% occlusion peroneal and PT arteries with reconstitution of the PT distally
-Moderate diffuse disease mid AT
-1 vessel run-off to the foot via the AT

LEFT LOWER EXTREMITY ANGIOGRAM:
-Moderated diffuse disease common femoral artery
-80% stenosis ostial SFA
-Widely patent self expanding stents seen in the mid and distal SFA
-80% calcified stenosis popliteal artery
-Below knee arteries not visualized in this study

Catheterization Procedure:
Access gained via the left common femoral artery and a 6F 70 cm Cook sheath was advanced to the level of the right common femoral artery. An Aquatrack wire was advanced through the distal SFA occlusion and exchanged for a Viper Wire. Elliptical artherectomy using 1.5 crown Diamondback device was performed in the popliteal, proximal mid and distal SFA followed by balloon angioplasty. Flow limiting dissection necessitated the placement of self expanding SMART stents measuring 7 x 150mm, 7 x 120 mm and 7 x 60mm from distal to proximal. The SFA was then dilated using 5mm and 6mm PTA balloons.
I hope there is more to the report than this. Based on this, I would only code 37227. He has diagnostic findings, but that procedure is not documented in this report. Catheterization to the treated extremity are included in 37227, so unless there were additional access points and/or additional work outside this extremity, you cannnot code 36247, 36200, 36140. (36200 and 36140 would require separate 2 additional separate accessess, 36247.
 

coders_rock!

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Thank you for responding Donna. I am posting several reports because I want to learn and get it right.

This is it for the report. It's difficult for me to learn interventional radiology when the provider's documentation isn't clear.

So, in this case, you are saying that 37227 is the only code reportable. 75716 is not because although findings are indicated, it is not mentioned in the body of the report. In order to bill 36140, 36200, 36247, separated accesses needed to be obtained? Am I correct?
 

donnajrichmond

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Thank you for responding Donna. I am posting several reports because I want to learn and get it right.

This is it for the report. It's difficult for me to learn interventional radiology when the provider's documentation isn't clear.

So, in this case, you are saying that 37227 is the only code reportable. 75716 is not because although findings are indicated, it is not mentioned in the body of the report. In order to bill 36140, 36200, 36247, separated accesses needed to be obtained? Am I correct?
Yes, you are correct. The revascularization codes (37220 - 37235) include catheterization to the treated area and any non-selective catheterizations on the way there. If other areas outside of the treated leg are selectively catheterized, then you can code that. These codes also include imaging involved in the revascularization. CPT book has very specific guidelines for when a diagnostic angiogram S & I code (75716 in your example) can and cannot be coded when an intervention is done. See the guidelines before code 75600 in CPT.
I think a mistake you are making is to code a catheterization at every place the doctor start and goes. You must know where the doctor started (his access) but you don't code for that - it just helps you to know what to code later. You also don't code a catheterization code when the doctor goes through one vessel to get to another, even if he stops and does an angiogram. You can code the S & I for the angio, but you code the furtherest catheterization. And, you drop non-selective codes once you have gone selective from the same access. So, in your case, I think you probably coded 36140 for the access into the left common femoral. If he had stopped there and not gone anywhere else, then that would be correct. But he didn't stop, he kept going so you don't code 36140. 36200 is catheterization of the aorta and I don't see that at all in this report, so I'm not sure where you got that. However, if you do go to the aorta, but then select any other vessel, you would drop 36200 (assuming same access). And 36247 would be the correct catheterization if they had just done a diagnostic angiogram (left groin across the bifurcation through common iliac, external iliac/common femoral, SFA and beyond). However, since they also did the revascularization (atherectomy, angioplasty, stent), you cannot code this catheterization code as it is included in 37227. I don't want to confuse you, but if after the revascularization of the right leg he had gone up and selected the right common carotid for an angiogram you would have been able to add the catheterization for the right common carotid (36216) and the S & I (75676) because that is a separate area from the revascularization.
 
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