Coding help please

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INDICATION: Symptom-limiting claudication.
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PERIPHERAL ANGIOGRAPHY REPORT .
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PROCEDURE: Access left common femoral artery with catheter placement, third order, aortoiliofemoral angiogram with bilateral lower extremity runoff.
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HISTORY OF PRESENT ILLNESS: The patient is a 59-year-old with coronary artery disease, previous PCI, hypertension, dyslipidemia, obesity, PAD who presents with symptom-limiting right lower extremity claudication. He had noninvasive studies that demonstrated critical stenosis in the right lower extremity. He is referred for correlative imaging with angiography.
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CONSENT: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. .
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PROCEDURE DESCRIPTION: The left groin was prepped in the usual sterile fashion, and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Left common femoral artery was accessed using modified Seldinger technique in which a 5 French 11-cm sheath was placed. An Omniflush catheter was then advanced into the abdominal aorta for aortoiliofemoral angiography with interpretation, and then a wire was used to direct the Omniflush to the common femoral artery on the contralateral side with selective injection for a right lower extremity runoff as well as injection through the sheath for a left lower extremity runoff. At the conclusion of the procedure, manual compression was used for arterial hemostasis.
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FINDINGS: The abdominal aorta was normal in caliber without stenosis. The right common iliac artery was normal in caliber without stenosis. The internal and external right iliac were normal in caliber without stenosis. The common femoral was normal in caliber without stenosis. The SFA was normal in caliber, however, was occluded in the distal SFA with collateralization and reconstitution just in the superior aspect of the popliteal just above knee. The popliteal was otherwise clear of disease with 3-vessel runoff. The right profunda also was normal in caliber without stenosis. The left common iliac was normal in caliber without stenosis. The internal and external left iliacs were normal in caliber without stenosis. The common femoral on the left side was also normal in caliber without stenosis. The SFA, profunda, popliteal were all normal in caliber without stenosis with 3-vessel runoff. Manual compression was used for hemostasis.
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SUMMARY: Severe right SFA disease with total occlusion of the distal SFA with reconstitution through collateralization in the superior aspect of the popliteal artery.
I have 36140
36437-26
and 75635 I am not sure about these codes.
 

schmsuz

Networker
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I would code this as 36246 (contralateral in the common femoral) and 75716-26 (bilateral extremity angio). Both contralateral and ipsilateral studies were done from the same access site, so 36140 cannot be billed.
 

Jim Pawloski

True Blue
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Can you give me the reason why it is not 75635 please Thank you

I would not code for the abdominal aorta because there is not documentation of the renals arteries or visceral arteries. Since the catheter was placed in the very distal abdominal aorta, I would code 36246-Rt for the catheter position, and 75716 for bilateral extremity arteriogram.

HTH,
Jim Pawloski, R.T.(CV), CIRCC
 
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