Renal Angiography

drobinson1

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Wilmington, DE
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Catherizations continue to haunt me. I have a question and I hope someone out there can help me. Here is the part of the report. I posted my question at the bottom.

A right femoral approach was employed. The right groin was prepped and draped in a sterile fashion. Following local anesthesia, the right femoral artery was accessed and the 6French sheath placed within the artery over a guidewire. Some resistance to guidewire advancement was noted at the common iliac level on the right. Therefore, following placement of catheter to the distal aorta, a digital subtraction imaging of the right iliac system was performed. Although there is significant atherosclerotic disease, a catheter is not occlusive and no critical stenosis is seen. The deep femoral origin is noted to be patent. The origin of the superficial femoral on the right is occluded. The catheter was repositioned to the proximal abdominal aorta for digital subtraction AP aortogram. Next, the catheter was exchanged over a Glidewire for a 5 French C1 glide catheter. This was used to select both the main left renal artery for digital subtraction imaging as well as an accessory a lower pole branch which arises just proximal to the main renal artery from the aorta. In addition, 2 lumbar vessels on the left were selected for digital subtraction imaging in an effort to identified parasitic vessels to the left renal mass. Vascular supply to the left renal mass was found to arise only from the main left renal artery and the accessory lower pole branch.


The rest of the report explained the embolization. But my question is since a catheter was placed in the aorta but then it was exchanged before the renal arteries were selected do I code a non-selective catherization for the aorta (36200) or is it included in the renal angiography (new code 36251)?
 

dpeoples

True Blue
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889
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Birmingham, Alabama
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Catherizations continue to haunt me. I have a question and I hope someone out there can help me. Here is the part of the report. I posted my question at the bottom.

A right femoral approach was employed. The right groin was prepped and draped in a sterile fashion. Following local anesthesia, the right femoral artery was accessed and the 6French sheath placed within the artery over a guidewire. Some resistance to guidewire advancement was noted at the common iliac level on the right. Therefore, following placement of catheter to the distal aorta, a digital subtraction imaging of the right iliac system was performed. Although there is significant atherosclerotic disease, a catheter is not occlusive and no critical stenosis is seen. The deep femoral origin is noted to be patent. The origin of the superficial femoral on the right is occluded. The catheter was repositioned to the proximal abdominal aorta for digital subtraction AP aortogram. Next, the catheter was exchanged over a Glidewire for a 5 French C1 glide catheter. This was used to select both the main left renal artery for digital subtraction imaging as well as an accessory a lower pole branch which arises just proximal to the main renal artery from the aorta. In addition, 2 lumbar vessels on the left were selected for digital subtraction imaging in an effort to identified parasitic vessels to the left renal mass. Vascular supply to the left renal mass was found to arise only from the main left renal artery and the accessory lower pole branch.


The rest of the report explained the embolization. But my question is since a catheter was placed in the aorta but then it was exchanged before the renal arteries were selected do I code a non-selective catherization for the aorta (36200) or is it included in the renal angiography (new code 36251)?
No, the non-selective cath placement is included in the renal cath and angiography. The only instance I can think of that a catheter exchange is coded is a subsequent day catheter exchange for continued infusion.

HTH :)
 
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