Wiki Selective right renal artery arteriogram x2 (dual renal artery system)

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can some please help me with this.
36252 denied
I reviewed and now I am questioning if it should be 36253 RT and 36251 LT.
Any help is appreciated. thanks

Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. The patient was placed under monitored anesthesia care and bilateral groins were prepped and draped in the usual sterile fashion. A proper timeout was performed and agreed upon by all parties present. Ultrasound was used to gain access to the right common femoral artery. Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. A wire was passed into the external iliac artery and a 5 French sheath was placed and flushed with heparinized saline. Universal flush catheter was guided over 0.035 wire into the abdominal aorta and an abdominal aortogram was performed.

AORTOGRAM FINDINGS:
The abdominal aorta appears patent. The bilateral common iliac, internal iliac, external iliac arteries are patent
The sheath is exchanged over the Glidewire for a 7 French tour guide sheath. The right inferior renal artery from a dual renal artery system was selected out with the wire and catheter and selective arteriogram was performed which showed patency of the inferior renal artery throughout without stenosis. The wire and sheath were withdrawn into the aorta and redirected into the superior right renal artery from the dual renal system and selected out. An arteriogram of the superior renal artery showed no evidence of stenosis. The catheter was withdrawn back into the aorta and directed towards the left renal artery which was selected out and selective arteriogram of the left renal artery showed no evidence of renal artery stenosis. The catheter was withdrawn back into the aorta and then guided over the wire into the right iliac artery. The sheath was exchanged for a 7 French by 10 cm sheath and flushed with heparinized saline. The access site was closed with a 7 FrenchExoseal. Hemostasis was achieved. The patient tolerated the procedure well instrument transition to the recovery area in stable condition.
 
can some please help me with this.
36252 denied
I reviewed and now I am questioning if it should be 36253 RT and 36251 LT.
Any help is appreciated. thanks

Procedure Details:
After consent was obtained the patient was taken to the operative suite and laid in the supine position. The patient was placed under monitored anesthesia care and bilateral groins were prepped and draped in the usual sterile fashion. A proper timeout was performed and agreed upon by all parties present. Ultrasound was used to gain access to the right common femoral artery. Ultrasound-guided puncture was performed of the right common femoral artery using a micropuncture technique. Duplex was used to survey the site for vessel selection and puncture was performed under real-time ultrasound imaging. Imaging was documented of the guidance and placed in the patient's record. A wire was passed into the external iliac artery and a 5 French sheath was placed and flushed with heparinized saline. Universal flush catheter was guided over 0.035 wire into the abdominal aorta and an abdominal aortogram was performed.

AORTOGRAM FINDINGS:
The abdominal aorta appears patent. The bilateral common iliac, internal iliac, external iliac arteries are patent
The sheath is exchanged over the Glidewire for a 7 French tour guide sheath. The right inferior renal artery from a dual renal artery system was selected out with the wire and catheter and selective arteriogram was performed which showed patency of the inferior renal artery throughout without stenosis. The wire and sheath were withdrawn into the aorta and redirected into the superior right renal artery from the dual renal system and selected out. An arteriogram of the superior renal artery showed no evidence of stenosis. The catheter was withdrawn back into the aorta and directed towards the left renal artery which was selected out and selective arteriogram of the left renal artery showed no evidence of renal artery stenosis. The catheter was withdrawn back into the aorta and then guided over the wire into the right iliac artery. The sheath was exchanged for a 7 French by 10 cm sheath and flushed with heparinized saline. The access site was closed with a 7 FrenchExoseal. Hemostasis was achieved. The patient tolerated the procedure well instrument transition to the recovery area in stable condition.
Inferior renal artery is a branch. You are correct. The aortagram is included, should not be coded separately.
 
I would code 36251 and 76937 for selective Rt Renal Arteriogram w/ U/S vascular access.

HTH,
Jim Pawloski, CIRCC
Jim
would you please explain why just the 36251. I thought the RT and LT were selected. any and all education is appreciated. If you have any information that would be helpful please email it to me at khyatt@srhs.com
thanks
Kim
 
My error, I missed the left selective. So yes, code 36252 and 76937. Both arteries to the same kidney are coded as if it's a single artery.

Jim
 
My error, I missed the left selective. So yes, code 36252 and 76937. Both arteries to the same kidney are coded as if it's a single artery.

Jim
trying to learn so i have another question. I coded 36252 and 76937 it was denied. after rereading i thought about codes 36253 RT and 36251 LT. i thought inferior renal artery was a branch of the renal.
 
The inferior renal artery is considered as a branch, so should be coded as 36253-rt. 36251 is for left renal artery, also code 76937.
 
Last edited:
Per Dr. Z, "There may be multiple accessory renal arteries arising off the aorta. Selection and imaging of these vessels are bundled into codes 36251-36254. Accessory renal angiography (catheterization and imaging) is included in codes 36251-36254." 36251 and 36253 is for unilateral renals, 36252 and 36254 is for subselective renal angiography.

HTH,
Jim
 
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