Need coding help please

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INDICATION: Bilateral claudication and peripheral artery disease.
.
PROCEDURE: Access of right common femoral artery with third order catheter placement, bilateral aortoiliofemoral angiography with bilateral lower extremity runoff.
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HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old with a history of extensive coronary artery disease, peripheral artery disease, diabetes, dyslipidemia and hypertension with previous coronary artery bypass who presents with progressive symptoms of lower extremity claudication. The symptoms are bilateral; however, left greater than right. He had noninvasive imaging that suggested severe stenosis of his left SFA and moderate stenosis of the right SFA with ABIs of 0.56, respectively. He is referred for peripheral artery angiography.
.
PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The patient was taken to the catheterization laboratory and prepped in the supine position. Right common femoral access was performed with a 6-French sheath using modified Seldinger technique. An Omni Flush catheter was then placed in the abdominal aorta and digital subtraction angiography was then performed visualizing his abdominal aorta as well as his iliac system. Next, a catheter was then placed via guidewire access to his external iliac. Selective injection of his left lower extremity was then performed and interpreted. The catheter was then pulled back and through the 6-French sheath right lower extremity angiography was then performed and interpreted. At the conclusion of the procedure, manual compression was used for hemostasis.
.
FINDINGS: The abdominal aorta had moderate diffuse disease. The right common iliac had moderate to severe ostial disease with an internal iliac that had mild to moderate disease and the external iliac with mild to moderate disease. The common femoral had mild to moderate disease. The SFA had mild to moderate disease with mild calcification. The profunda had mild to moderate disease. The popliteal only had mild disease. There was 3-vessel runoff; however, there was severe diffuse disease in the posterior tibial vessel. On the left side, the common iliac had moderate to severe ostial stenosis. The internal iliac had mild to moderate disease and the external iliac had mild to moderate disease. The common femoral had mild to moderate disease. The SFA was subtotally occluded in the midvessel with extensive collateralization. The profunda had only mild to moderate disease with 3-vessel runoff after the popliteal that only had mild disease.
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SUMMARY: Severe left SFA disease with collateralization and subtotal occlusion. Bilateral intermediate ostial common iliac disease.
.

Visit Code:

Procedure Codes:
36140 ESTABLISH ACCESS TO ARTERY.

36247 PLACE CATHETER IN ARTERY.

75630 X-RAY AORTA, LEG ARTERIES.
This is what we have Thank you
 

Jim Pawloski

True Blue
Messages
1,391
Location
Ann Arbor
Best answers
1
INDICATION: Bilateral claudication and peripheral artery disease.
.
PROCEDURE: Access of right common femoral artery with third order catheter placement, bilateral aortoiliofemoral angiography with bilateral lower extremity runoff.
.
HISTORY OF PRESENT ILLNESS: The patient is an 80-year-old with a history of extensive coronary artery disease, peripheral artery disease, diabetes, dyslipidemia and hypertension with previous coronary artery bypass who presents with progressive symptoms of lower extremity claudication. The symptoms are bilateral; however, left greater than right. He had noninvasive imaging that suggested severe stenosis of his left SFA and moderate stenosis of the right SFA with ABIs of 0.56, respectively. He is referred for peripheral artery angiography.
.
PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The patient was taken to the catheterization laboratory and prepped in the supine position. Right common femoral access was performed with a 6-French sheath using modified Seldinger technique. An Omni Flush catheter was then placed in the abdominal aorta and digital subtraction angiography was then performed visualizing his abdominal aorta as well as his iliac system. Next, a catheter was then placed via guidewire access to his external iliac. Selective injection of his left lower extremity was then performed and interpreted. The catheter was then pulled back and through the 6-French sheath right lower extremity angiography was then performed and interpreted. At the conclusion of the procedure, manual compression was used for hemostasis.
.
FINDINGS: The abdominal aorta had moderate diffuse disease. The right common iliac had moderate to severe ostial disease with an internal iliac that had mild to moderate disease and the external iliac with mild to moderate disease. The common femoral had mild to moderate disease. The SFA had mild to moderate disease with mild calcification. The profunda had mild to moderate disease. The popliteal only had mild disease. There was 3-vessel runoff; however, there was severe diffuse disease in the posterior tibial vessel. On the left side, the common iliac had moderate to severe ostial stenosis. The internal iliac had mild to moderate disease and the external iliac had mild to moderate disease. The common femoral had mild to moderate disease. The SFA was subtotally occluded in the midvessel with extensive collateralization. The profunda had only mild to moderate disease with 3-vessel runoff after the popliteal that only had mild disease.
.
SUMMARY: Severe left SFA disease with collateralization and subtotal occlusion. Bilateral intermediate ostial common iliac disease.
.

Visit Code:

Procedure Codes:
36140 ESTABLISH ACCESS TO ARTERY.

36247 PLACE CATHETER IN ARTERY.

75630 X-RAY AORTA, LEG ARTERIES.
This is what we have Thank you


I would code this 36246-LT for the selective lt external iliac, and 75716 for the bilateral extremity arteriogram. Renals are not described to use 75630.
HTH,
Jim Pawloski, CIRCC
 

rbeaver

Networker
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I would code it 36246 Cath placement, 75716,26 bilateral and 75625,26 aortic viewing. You will a 59 or XS according to what insurance to the 75716,26.
 
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