RENAL ANGIOGRAPHIES & ANGIOPLASTY - CORRECT CODES

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36252 vs 36254 and how many Angioplasties? PROCEDURE: 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 replaced with a 5 French micropuncture
sheath/dilator set.  The wire was sized up to a 0.035" Newton
wire, and a 5 French Cook vascular sheath was placed into the
artery.  Via the arterial sheath a 4 French flush pigtail
catheter was advanced into the mid abdominal aorta and digital
subtraction angiography was performed.  The pigtail catheter was
removed and exchanged for a 4 French cobra catheter.  This
catheter was manipulated until it was in the left main renal
artery and DSA was performed in frontal projection. The angiogram
demonstrates two stenotic lesions involving two inferior branches
of the main renal artery.

Then, the cobra catheter was exchanged for a 4 French SOS
catheter and manipulated until it was in the right renal artery.
DSA was performed in frontal projection, and demonstrated two
areas of focal stenosis and beading involving the distal segment
of the inferior branch of the right main renal artery, and an
intrarenal lesion involving the upper pole of the right kidney.
The Newton wire was then exchanged for a 0.014" Radi wire which
was used to cross a lesion in the distal, inferior branch of
right main renal artery. Over the wire, a 3 x 10 mm Boston
Scientific coyote angioplasty balloon was used to dilate the
focal stenosis. Post angioplasty angiogram performed from the
proximal main renal artery demonstrated marked decrease of the
focal stenosis and no extravasation or arterial dissection. Then,
the Radi wire was exchanged for a 0.014" exchange length Nitrex
wire and this was manipulated into the upper pole intra-renal
lesion. Angioplasty was performed using a 1.5 x 20 mm angioplasty
balloon. Post angioplasty angiogram performed from the main renal
artery demonstrated marked decrease of the focal stenosis and no
extravasation or arterial dissection.

Then, the SOS catheter was used to again select the main left
renal artery. This was then exchanged for the cobra catheter. A
swift Ninja was then placed over the 0.014" Nitrex wire and a
lower branch off of the main left renal artery was crossed. This
was then angioplastied using a 1.5 x 20 mm Boston Scientific
angioplasty balloon. Then, the Nitrex wire was exchanged for an
0.010" guidewire and over the wire, the swift Ninja was used to
cross the second identified lesion off a lower branch of the main
left renal artery.  This was angioplastied using a 1.5 x 20 mm
angioplasty balloon. Post angioplasty angiogram performed from
the main renal artery demonstrated decrease of the two stenotic
lesions and no extravasation or arterial dissection.

Of note, angiogram of the accessory left renal artery did not
demonstrate focal stenosis amenable to intervention.
 

suchang78

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RT renal artery:
36251-RT - catheter was advanced in the right renal artery.
37246 and 37247 angioplasties for the distal segment of the inferior branch and the upper pole intrarenal in the right renal artery.
36253-Lt - The catheter was across to the lower branch of the left renal artery( It was beyond the main renal artery)
37427 - angioplasty for the lower branch of the left renal artery( I assumed 2 lesions were angioplastied in the same target zone as the lower branch of the left renal artery, so only one angioplasty code for this performance)
 
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Thanks so much...….question....for Left Angiography,...…..i don't see the documentation for the catheter being anywhere but in the left main renal for the Angiography...…...it was crossed for the Angioplasty, but I do not see documentation of an Angiography with catheter in the lower branch...………...since catheter WAS placed in branch for Angioplasty, would we still code it as an angiography....or is it because the catheter was manipulated to a branch for the angioplasty?
.Thank you so so much.
 

suchang78

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Baldwin Park, CA
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Thanks so much...….question....for Left Angiography,...…..i don't see the documentation for the catheter being anywhere but in the left main renal for the Angiography...…...it was crossed for the Angioplasty, but I do not see documentation of an Angiography with catheter in the lower branch...………...since catheter WAS placed in branch for Angioplasty, would we still code it as an angiography....or is it because the catheter was manipulated to a branch for the angioplasty?
.Thank you so so much.
After I reviewed it again. I have to correct my answers, It should be 36252 and assign 2 angioplasties for the left renal arteries ( when I looked back the 1st paragraph "The angiogram demonstrates two stenotic lesions involving two inferior branches of the main renal artery." and 2 angioplasties for the right renal arteries."
 
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