Wiki PV question


Indianapolis, IN
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I am getting differing opinions on this and am getting more confused. The right subclavian was engaged and angiography performed with runoff into the carotid and vertebral arteries. Angled glidewire advanced to the right internal carotid with cerebral angiography. I had 36218 for the internal rt carotid with 75665, 75676, 75710 and 75685. Someone else told me to code 36218 for the right subclavian, then 36216 for the right common carotid, plus the S&I codes I already listed. I just am not understanding the reason for this.
If this was a right subclavian approach, the Right Internal would be a 36216.
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Was it truly done from a subclavian approach, or was it a femoral approach with selective catheter placement into the subclavian and right internal carotid?

Assuming this was done from a femoral approach and patient has normal anatomy (not bovine arch), for the cath placements, you have:

36217 (Right internal carotid, if CATH was placed - always code to the highest order within a vascular family)
36218 (Right subclavian)

If access was from the subclavian, then you just have 36216 for the right internal carotid catheterization, as the subclavian is non-selective.

I'm not sure I would code 75676 unless the physician documents specific findings for the common carotid artery. I also wouldn't code 75710 if the intent of injecting in the subclavian was to view the vertebral - that is captured in 75685.

If you have a full copy of the report you can post, it would better help us determine the correct coding for this case. Placing a wire in the internal carotid artery doesn't necessary constitute selective catheterization unless he actually placed a catheter there and took images.