Help! - ABDOMINAL AORTOGRAM

amym

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I need help coding this, please!

ABDOMINAL AORTOGRAM WITH BILATERAL LOWER EXTREMITY RUNOFF:

Indication: Bilateral claudication, left worse than right.
Abnormal non-invasive imaging indicating severe disease.

Summary: The patient was brought to the cath lab. He has history
of dye allergy, and Solu-Cortef and Benadryl 50 mg were given and
Versed, 2 mg, was used for sedation. The patient tolerated the
procedure well. Visipaque was used, total contrast used was 90 mL
of contrast. CO2 injection was used for abdominal aortogram.

Findings: The abdominal aorta demonstrates normal caliber with no
significant disease. There are two renal arteries on the right side
and one on the left, and they both appear to indicate no significant
disease, although the imaging was suboptimal. The bifurcation is
intact with no disease seen. Bilateral common iliac, external
iliac, common femoral, and superficial femoral arteries are normal
in both right and left circulation. The right infrapopliteal
circulation reveals two-vessel runoff on the right and one-vessel
runoff on the left. The right anterior tibial artery is occluded,
and the right posterior tibial artery is also proximally occluded,
however, it reconstitutes and has good flow running into the foot.
There is mild disease of the peroneal artery, which is the dominant
artery in the right leg. The left infrapopliteal circulation
reveals the following: Both anterior tibial and posterior tibial
arteries on the left side are totally occluded. Single-vessel
runoff is present with the peroneal artery being the only remaining
good vessel. The junction of the upper and lower thirds of the
peroneal artery demonstrate at least 50-60% plaque formation or
stenosis, which is also leading up to a more normal-appearing distal
vessel. There is collateral filling above the ankle and then
subsequently single-vessel runoff into the foot. Of note, the
patient has palpable dorsalis pedis arteries in both feet.

Impression:

1. Significant infrapopliteal vascular disease with occlusion
involving the left anterior tibial and posterior tibial arteries
with single-vessel runoff on the left side.
2. Normal-appearing abdominal aorta and proximal arteries in the
legs.
 

dpeoples

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I need help coding this, please!

ABDOMINAL AORTOGRAM WITH BILATERAL LOWER EXTREMITY RUNOFF:

Indication: Bilateral claudication, left worse than right.
Abnormal non-invasive imaging indicating severe disease.

Summary: The patient was brought to the cath lab. He has history
of dye allergy, and Solu-Cortef and Benadryl 50 mg were given and
Versed, 2 mg, was used for sedation. The patient tolerated the
procedure well. Visipaque was used, total contrast used was 90 mL
of contrast. CO2 injection was used for abdominal aortogram.

Findings: The abdominal aorta demonstrates normal caliber with no
significant disease. There are two renal arteries on the right side
and one on the left, and they both appear to indicate no significant
disease, although the imaging was suboptimal. The bifurcation is
intact with no disease seen. Bilateral common iliac, external
iliac, common femoral, and superficial femoral arteries are normal
in both right and left circulation. The right infrapopliteal
circulation reveals two-vessel runoff on the right and one-vessel
runoff on the left. The right anterior tibial artery is occluded,
and the right posterior tibial artery is also proximally occluded,
however, it reconstitutes and has good flow running into the foot.
There is mild disease of the peroneal artery, which is the dominant
artery in the right leg. The left infrapopliteal circulation
reveals the following: Both anterior tibial and posterior tibial
arteries on the left side are totally occluded. Single-vessel
runoff is present with the peroneal artery being the only remaining
good vessel. The junction of the upper and lower thirds of the
peroneal artery demonstrate at least 50-60% plaque formation or
stenosis, which is also leading up to a more normal-appearing distal
vessel. There is collateral filling above the ankle and then
subsequently single-vessel runoff into the foot. Of note, the
patient has palpable dorsalis pedis arteries in both feet.

Impression:

1. Significant infrapopliteal vascular disease with occlusion
involving the left anterior tibial and posterior tibial arteries
with single-vessel runoff on the left side.
2. Normal-appearing abdominal aorta and proximal arteries in the
legs.

We all may know the doc used a catheter in the aorta to inject, but he/she did not document that very basic information. I would ask for a revision or I would not code 36200. As for the rest, I would code 75630 instead of 75625/75716 because no catheter retraction to the bifurcation is documented. Perhaps there is more to the report than is posted here?

HTH :)
 
Last edited:

dimmitta

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We all may know the doc used a catheter in the aorta to inject, but he/she did not document that very basic information. I would ask for a revision or I would not code 36200. As for the rest, I would code 75630 instead of 75625/75716 because no catheter retraction to the bifurcation is documented. Perhaps there is more to the report than is posted here?

HTH :)
I agree that the catheter placement is not the most clear here and that does make it hard to tell which codes should be billed. However, I would disagree with 75630. Every discussion I have ever heard regarding 75630 is that when this is performed the catheter is below the renal arteries and you would only have imaging to the knee.

Since the op note did show finding related to the renals would that not give credit that the cath was indeed up higher and then pulled low to give findings on both the bifurcation status and provide imaging all the way to the foot?

Just curious :) I love hearing how other people reason! Have a great weekend!
 

dpeoples

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I agree that the catheter placement is not the most clear here and that does make it hard to tell which codes should be billed. However, I would disagree with 75630. Every discussion I have ever heard regarding 75630 is that when this is performed the catheter is below the renal arteries and you would only have imaging to the knee.

Since the op note did show finding related to the renals would that not give credit that the cath was indeed up higher and then pulled low to give findings on both the bifurcation status and provide imaging all the way to the foot?

Just curious :) I love hearing how other people reason! Have a great weekend!
You're correct in that the renals are usually a good landmark to help distinquish 75630 from 75625, but those are all subjective discussions. Renals artery locations or images are not part of the code description for either code and therefore should not be the sole criteria IMO. My hard and fast rule ( not always 100%) is one injection=one code, two injections=two codes. My guess is your code scenario is probably the accurate one, but the documentation does not clearly support it.

Have a good weekend yourself..
HTH :)
 
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