NEED HELP CODING NEURSURGERY VASCULAR SURGERY PLEASE!

sshill

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Mckinney, Texas
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If someone could review surgery report below and advise, greatly appreciated!! I have lots of neurosurgery experience, but minimal neurovascular:

Transfemoral cerebral angiogram with sonographic assistance via portable ultrasound for femoral access.
  1. Selective right internal carotid artery injection with three dimensional reconstruction at a separate workstation.
    Right common femoral artery injection and placement of AngioSeal closure device.
    Supervision and interpretation.

  2. DETAILS OF PROCEDURE: After the patient was brought to the INR suite, he was identified and placed supine on the INR table. Conscious sedation anesthesia was induced. Bilateral groins were prepped and draped in the usual sterile fashion. Following appropriate time-out, with sonographic assistance from a portable Ultrasound machine, which was prepped and draped in the usual sterile fashion the right common femoral region was anesthetized with 2% lidocaine. With the Seldinger technique, theRight common femoral artery was catheterized with a 5-French sheath which was hooked to continuous heparinized flush. With a 5-French Berenstein catheter and a 0.038 Terumo guidewire, the aorta was ascended up the arch.

    Selectively, the right common carotid artery was catheterized. The wire was removed. System was flushed. Flow was checked. A roadmap of the AP and lateral views did not show any evidence of artherosclerotic disease of the bifurcation.

    Selectively, the right internal carotid artery was catheterized. The wire was removed. System was flushed. Flow was checked. Multiple runs in multiple views with three dimensional reconstruction at a separate workstation including high magnification views showed 80% obliteration of the aneurysm with 20% wide neck recurrence and WEB compaction at the dome. There were no new aneurysms, AVM, or other vascular abnormalities.

    The right common femoral artery was catheterized. There was normal proximal iliac and distal superficial and profunda segments.
 

ernist8489

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60
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Salt Lake City, UT
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In this case youre going to report CPT code 36224-RT for the selective right internal carotid artery angio which includes angiography of the internal carotid and cerebral circulations. The right common carotid selective injection is bundled into 36224-RT as the Right common carotid is the vessel which precludes the internal and external carotids. Because the common is a lesser order vessel, and you must first select the right common to get to the 3rd order right internal carotid then we report the highest order vessel selectively catheterized in a family which is the internal in this case, and these codes also bundle the angiography of the cerviccocerebral arch and intracranial circulation.
 
Messages
87
Location
Sulphur, KY
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If someone could review surgery report below and advise, greatly appreciated!! I have lots of neurosurgery experience, but minimal neurovascular:

Transfemoral cerebral angiogram with sonographic assistance via portable ultrasound for femoral access.
  1. Selective right internal carotid artery injection with three dimensional reconstruction at a separate workstation.
    Right common femoral artery injection and placement of AngioSeal closure device.
    Supervision and interpretation.

  2. DETAILS OF PROCEDURE: After the patient was brought to the INR suite, he was identified and placed supine on the INR table. Conscious sedation anesthesia was induced. Bilateral groins were prepped and draped in the usual sterile fashion. Following appropriate time-out, with sonographic assistance from a portable Ultrasound machine, which was prepped and draped in the usual sterile fashion the right common femoral region was anesthetized with 2% lidocaine. With the Seldinger technique, theRight common femoral artery was catheterized with a 5-French sheath which was hooked to continuous heparinized flush. With a 5-French Berenstein catheter and a 0.038 Terumo guidewire, the aorta was ascended up the arch.

    Selectively, the right common carotid artery was catheterized. The wire was removed. System was flushed. Flow was checked. A roadmap of the AP and lateral views did not show any evidence of artherosclerotic disease of the bifurcation.

    Selectively, the right internal carotid artery was catheterized. The wire was removed. System was flushed. Flow was checked. Multiple runs in multiple views with three dimensional reconstruction at a separate workstation including high magnification views showed 80% obliteration of the aneurysm with 20% wide neck recurrence and WEB compaction at the dome. There were no new aneurysms, AVM, or other vascular abnormalities.

    The right common femoral artery was catheterized. There was normal proximal iliac and distal superficial and profunda segments.
36224-RT,76377-26,76937-26
 
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