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Renal angiog from aorta and select.renal

Messages
177
Best answers
0
Hi, Guys,
For report below, the cath is in the aorta for a right renal angiogram. Then a selective catheterization of left renal artery and subsequent angioplasty of left rena.
QUESTION: Do I bill for the RS&I for the aortogram?...75625? Or do I just code for the Left DSA and left Angioplasty?
36253, 76937, 35471, 75966?....76937 as US guidance for angiographies...do you think it meets criteria?
Margie

PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Selective catheterization of the superior and inferior
branches of the left main renal artery and angioplasty using 1.5
mm balloon catheter.
6. Post angioplasty angiogram of the left renal artery and
abdominal aorta.
7. Hemostasis with manual compression.

PROCEDURE IN DETAILS: The skin of the right groin was prepped and
draped in sterile fashion. Using US guidance a 21-gauge needle
was inserted in the right common femoral artery. Once arterial
blood return was obtained a .018" Nitrex wire was placed into the
artery and advanced to the distal abdominal aorta. The needle was
removed and a 5 French 45 cm curved vascular sheath was placed
into the artery and advanced into the abdominal aorta. Then a 4
French 70 cm pigtail catheter was advanced into the proximal
abdominal aorta and angiography of the abdominal aorta and renal
and adrenal arteries in oblique view was obtained utilizing
digital subtraction angiography. The catheter was exchanged into
4 French Sos Omni catheter and selective catheterization of the
left renal artery was performed and angiogram was obtained
utilizing digital subtraction angiography.

FINDINGS:
AORTOGRAM:
The abdominal aorta, visualized branches of the celiac artery and
SMA and aortic bifurcation are normal in caliber without evidence
of stenosis. There is significant discrepancy in renal size.
There is differential perfusion of the kidneys with significant
decrease of left renal perfusion, most pronounced within the
inferior portion. The venous phase demonstrates small left renal
vein with normal right renal vein suprarenal IVC.

LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. The origin of the left renal artery is normal in
appearance without evidence of stenoses. There is tight
bifurcation stenosis involving the most distal portion of the
left renal artery as well as the proximal superior and inferior
branches. There is mild post stenosis dilatation, primarily
involving the superior branch.

There is no vascular malformation or aneurysm.

RIGHT RENAL ARTERY ANGIOGRAM: There are 2 renal arteries on the
right. The right renal arteries arteries are unremarkable with no
evidence of stenoses. The intra-renal perfusion and intra-renal
vasculature is normal. There is no vascular malformation or
aneurysm. The right renal vein is unremarkable.

LEFT RENAL ANGIOPLASTY:
The images were reviewed carefully and the decision of
angioplasty of the left renal artery bifurcation was made. The
initial dose of heparin was given. The heparin was given
throughout the procedure with continuous monitoring of ACT. Then
selective catheterization of the left renal artery was performed
utilizing 5 French Sos Omni catheter. Then 0.014 Thruway wire was
advanced into the superior branch and additional 0.014 Approach
wire was advanced into the inferior branch. The Sos Omni catheter
was removed and angioplasty was performed utilizing 1.5 mL
monorail balloon catheter (inflated to 1.5 mm at 14 atm.).
Initially angioplasty of the superior branch was performed then
the inferior branch. Then a 3 French pigtail catheter was
advanced into the proximal abdominal aorta and angiogram was
obtained. Post angioplasty angiogram of the left renal artery
demonstrated significant radiologic improvement of the stenosis
without evidence of thrombosis, dissection or extravasation.

The sheath and the wires were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. There were no complications and
the patient left the IR Suite in stable condition. Dr. was
present for the entire procedure.

Permanent fluoroscopic and US images were obtained and stored in
the PACS system.

Complications: Small hematoma was noted at the right groin.

IMPRESSION
IMPRESSION
 

Jim Pawloski

True Blue
Messages
1,244
Location
Ann Arbor
Best answers
0
Hi, Guys,
For report below, the cath is in the aorta for a right renal angiogram. Then a selective catheterization of left renal artery and subsequent angioplasty of left rena.
QUESTION: Do I bill for the RS&I for the aortogram?...75625? Or do I just code for the Left DSA and left Angioplasty?
36253, 76937, 35471, 75966?....76937 as US guidance for angiographies...do you think it meets criteria?
Margie

PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Selective catheterization of the superior and inferior
branches of the left main renal artery and angioplasty using 1.5
mm balloon catheter.
6. Post angioplasty angiogram of the left renal artery and
abdominal aorta.
7. Hemostasis with manual compression.

PROCEDURE IN DETAILS: The skin of the right groin was prepped and
draped in sterile fashion. Using US guidance a 21-gauge needle
was inserted in the right common femoral artery. Once arterial
blood return was obtained a .018" Nitrex wire was placed into the
artery and advanced to the distal abdominal aorta. The needle was
removed and a 5 French 45 cm curved vascular sheath was placed
into the artery and advanced into the abdominal aorta. Then a 4
French 70 cm pigtail catheter was advanced into the proximal
abdominal aorta and angiography of the abdominal aorta and renal
and adrenal arteries in oblique view was obtained utilizing
digital subtraction angiography. The catheter was exchanged into
4 French Sos Omni catheter and selective catheterization of the
left renal artery was performed and angiogram was obtained
utilizing digital subtraction angiography.

FINDINGS:
AORTOGRAM:
The abdominal aorta, visualized branches of the celiac artery and
SMA and aortic bifurcation are normal in caliber without evidence
of stenosis. There is significant discrepancy in renal size.
There is differential perfusion of the kidneys with significant
decrease of left renal perfusion, most pronounced within the
inferior portion. The venous phase demonstrates small left renal
vein with normal right renal vein suprarenal IVC.

LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. The origin of the left renal artery is normal in
appearance without evidence of stenoses. There is tight
bifurcation stenosis involving the most distal portion of the
left renal artery as well as the proximal superior and inferior
branches. There is mild post stenosis dilatation, primarily
involving the superior branch.

There is no vascular malformation or aneurysm.

RIGHT RENAL ARTERY ANGIOGRAM: There are 2 renal arteries on the
right. The right renal arteries arteries are unremarkable with no
evidence of stenoses. The intra-renal perfusion and intra-renal
vasculature is normal. There is no vascular malformation or
aneurysm. The right renal vein is unremarkable.

LEFT RENAL ANGIOPLASTY:
The images were reviewed carefully and the decision of
angioplasty of the left renal artery bifurcation was made. The
initial dose of heparin was given. The heparin was given
throughout the procedure with continuous monitoring of ACT. Then
selective catheterization of the left renal artery was performed
utilizing 5 French Sos Omni catheter. Then 0.014 Thruway wire was
advanced into the superior branch and additional 0.014 Approach
wire was advanced into the inferior branch. The Sos Omni catheter
was removed and angioplasty was performed utilizing 1.5 mL
monorail balloon catheter (inflated to 1.5 mm at 14 atm.).
Initially angioplasty of the superior branch was performed then
the inferior branch. Then a 3 French pigtail catheter was
advanced into the proximal abdominal aorta and angiogram was
obtained. Post angioplasty angiogram of the left renal artery
demonstrated significant radiologic improvement of the stenosis
without evidence of thrombosis, dissection or extravasation.

The sheath and the wires were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. There were no complications and
the patient left the IR Suite in stable condition. Dr. was
present for the entire procedure.

Permanent fluoroscopic and US images were obtained and stored in
the PACS system.

Complications: Small hematoma was noted at the right groin.

IMPRESSION
IMPRESSION
Hi Margaret,
The abdominal aorta is bundled into renal angio. So you have 36251 for the selective lt renal, 35471/ 75966 for the angioplasty.
HTH,
Jim Pawloski, CIRCC
 
Messages
177
Best answers
0
Renal angios

Jim,
So, I looked again at the selective renal angios, and i see where i erred in thinking it was a superselective, because dr. went into branches....For a superselective, must there be an additional puncture, and dr. will say superselective?
Also....I see that you do not use the 76937....I used it because dr. documents accessing the femoral artery using US guidance.....so if dr. kept documenting US guidance for accessing the renals, would you then bill it?
Under what circumstances might you code the 76937, or do you not use it at all?
Thanks so much for your help.
Margie
 

Jim Pawloski

True Blue
Messages
1,244
Location
Ann Arbor
Best answers
0
Jim,
So, I looked again at the selective renal angios, and i see where i erred in thinking it was a superselective, because dr. went into branches....For a superselective, must there be an additional puncture, and dr. will say superselective?
Also....I see that you do not use the 76937....I used it because dr. documents accessing the femoral artery using US guidance.....so if dr. kept documenting US guidance for accessing the renals, would you then bill it?
Under what circumstances might you code the 76937, or do you not use it at all?
Thanks so much for your help.
Margie
Superselective must be in one of the branches of the renal. He stated that he was at the bifurcation, not superselective. Also, the Dr. must say that a U/S image was taken and either placed in the chart or sent to PACS to get 76937, and describe the patiency of the vessel to get the charge.
HTH,
Jim Pawloski, CIRCC
 
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