Wiki Decision to intervene

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I have a question concerning the requirements for billing diagnostic angiography. Does the doctor have to actually state the phrase "Decision to intervene was based on today's study, no other prior catheter based studies available? I ask because I have a case that was a trauma and the doctor didn't actually state decision to intervene but I felt what he did state met the requirment. Please read below and give my opinions. Thanks!

Result Narrative
Splenic artery angiogram and splenic artery embolization.

History: This is a 31-year-old female who had a traumatic splenic laceration last night. CT scan performed today demonstrated a high-grade splenic laceration. She has a perisplenic hematoma and free fluid in her abdomen and pelvis. We have been asked by the trauma service to perform embolization.

Timeout procedure was performed. She was prepped and draped in the usual sterile fashion. Lidocaine was used for local anesthesia. Micropuncture set was used to gain access into the right common femoral artery. Guidewire was advanced, the tract dilated and a 6-French sheath placed in the right common femoral artery. A 6-French guiding catheter was then inserted. Through this a Motarjeme catheter was inserted. The Motarjeme catheter was used to selectively catheterize the splenic artery. A splenic angiogram was performed. Splenic angiogram demonstrated splenic laceration as was seen on the CT examination. No pseudoaneurysm or extravasation of contrast was visualized. The main splenic artery was embolized using a 6 mm Amplatz device. Followup angiogram demonstrated good position of the device with occlusion of the main splenic artery at device location. There was reconstitution of distal branches by short gastric collaterals.

The patient tolerated the procedure well, and there were no immediate complications.

An Angio-Seal was deployed in the right common femoral artery following the procedure.
 
I have a question concerning the requirements for billing diagnostic angiography. Does the doctor have to actually state the phrase "Decision to intervene was based on today's study, no other prior catheter based studies available? I ask because I have a case that was a trauma and the doctor didn't actually state decision to intervene but I felt what he did state met the requirment. Please read below and give my opinions. Thanks!

Result Narrative
Splenic artery angiogram and splenic artery embolization.

History: This is a 31-year-old female who had a traumatic splenic laceration last night. CT scan performed today demonstrated a high-grade splenic laceration. She has a perisplenic hematoma and free fluid in her abdomen and pelvis. We have been asked by the trauma service to perform embolization.

Timeout procedure was performed. She was prepped and draped in the usual sterile fashion. Lidocaine was used for local anesthesia. Micropuncture set was used to gain access into the right common femoral artery. Guidewire was advanced, the tract dilated and a 6-French sheath placed in the right common femoral artery. A 6-French guiding catheter was then inserted. Through this a Motarjeme catheter was inserted. The Motarjeme catheter was used to selectively catheterize the splenic artery. A splenic angiogram was performed. Splenic angiogram demonstrated splenic laceration as was seen on the CT examination. No pseudoaneurysm or extravasation of contrast was visualized. The main splenic artery was embolized using a 6 mm Amplatz device. Followup angiogram demonstrated good position of the device with occlusion of the main splenic artery at device location. There was reconstitution of distal branches by short gastric collaterals.

The patient tolerated the procedure well, and there were no immediate complications.

An Angio-Seal was deployed in the right common femoral artery following the procedure.

The quick and easy answer is "no", they do not have to specifically state "decision to intervene...". In fact, cases like this are usually a very good example of a diagnostic angiography prior to intervention.

However, in this case, at CT (CTA?) was performed earlier which "diagnosed" the problem. Therefore, I do not think this warrants a diagnostic angiography.

Without that info? Yes.

clear as mud right?

HTH
 
One more question on this....71260, 74177 chest ct and chest/pelvis ct were done but these are not CTA's. I was understanding that we could not bill if any other cta (angiogram) was performed. In this case I would think we would be ok to bill since only regular ct's were done. Thoughts?!?! Thanks, Sue
 
One more question on this....71260, 74177 chest ct and chest/pelvis ct were done but these are not CTA's. I was understanding that we could not bill if any other cta (angiogram) was performed. In this case I would think we would be ok to bill since only regular ct's were done. Thoughts?!?! Thanks, Sue

That small detail would change my previous answer. Yes, diagnostic angiography should be billed in addition to the embolization.

HTH :)
 
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