Wiki Interventional Radiology


Elizabethtown, KY
Best answers
I am new to IR coding & needing some help, please.

Procedure: Percutaneous aortogram w/ bilateral pelvic angiograms with interpretation
Bilateral lower extremity runoff
Bilateral common iliac artery kissing balloon angioplasty and covered stenting

OP note: Patient was taken to the peripheral vascular lab & placed in the supine position on the table. After sterile prep & drape, a time out was taken. 1% Lidocaine was used to anesthetize the skin & subcutaneous tissue left groin. Using real-time, & dynamic sterile US guidance the left common femoral artery was accessed in a retrograde fashion with a micropuncture needle. A 5 French short sheath was placed w/ fluoroscopic guidance. A stiff angled, 035 glidewire was advanced into the abdominal aorta. An Omni flush catheter was placed & an aortogram was obtained using the power injector. The decision to intervene was made based on these findings. Next similar access was obtained in the right groin & using the same technique. An 035 glidewire was then used to successfully negotiate the after mentioned lesions in the right common iliac artery. 5000 units of heparin were given by the nurse & 3 minutes were allow to pass. Exchange out for 035 Magic torque wires bilaterally as a working wires. Next an 8 x 4 balloon was used to the left side an 8 x 60 balloon was used on the right side perform kissing balloon angioplasties of the proximal common iliac arteries. Then I cast stents were prepared. An 8 x 38 stent was used to the left-sided an 8 x 39 was used to the right side. These were deployed simultaneously using the kissing balloon technique. I did raise the aortic bifurcation 1 cm, on purpose. This was needed base of the location of the plaque. Follow up angiogram revealed excellent stent placement w/ no complications. Bilateral minx device were deployed successfully and the patient tolerated the procedure well.
I am looking at 37221, 37223, 75716, but I am not sure.

Hi am new to all this as well. I was told to use a modifier 59 on a technical charge. Do you know if this is correct?

For kissing stent you would actually report 37221 x 2. CPT instruction is to use the additional vessel codes "For bifurcation lesions distal to the common iliac origins". How you modify this will be up to your payer guideline (59 vs 50 vs RT/LT).

I'm unclear what kind of arteriography was actually performed, but it would likely be 75716 or 75630. You will need to modify this as well to bypass NCCI.
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