tdrewes
New
This is a new speciality for me. Can anyone assist with information on coding of the spinal angiogram? Here is op note. Provider has coded as following
36223,50
36226,50
75710,26
36215,59 X26
75705,26 X26
This is a cervical, cerebral, and spinal angiogram for patient with cervical cord vascular lesion. Angiogram was requested to rule out an arteriovenous malformation in the spinal cord. Consent was obtained from patient prior to procedure, patient was aware of the risks and benefits associated with the procedure. Patient agreed and consented. Patient is dialysis dependent, is scheduled to undergo hemodialysis after this procedure.
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Patient was identified and brought to the Neuro Interventional Radiology suite, time-out was completed. Patient was prepped and draped in the usual sterile fashion. Using modified Seldinger technique, a 5 French sheath was advanced right common femoral artery. Diagnostic Sim 2 catheter was then advanced the aortic arch. I selected the left common carotid artery and the left subclavian artery with this catheter. I then selected the left vertebral artery, right common carotid artery, and the right vertebral artery and right subclavian artery with the vert catheter. Vessels were selected and multiple angiographic views were obtained from each vessel. After finishing this part, I went ahead and used a Mik diagnostic catheter to select the spinal segmental arteries. I selected all the segmental arteries from T4 all the way down to L4 segment. I also selected bilateral iliac arteries. At the end of procedure selected the right common femoral artery and did an angiographic run then closed the arteriotomy site with a Mynx device.
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Findings: 1. Left subclavian artery arteriogram: Left subclavian artery is normal. Origin of the left vertebral artery is within normal limits.
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2. Selective left vertebral artery arteriogram: Left vertebral artery is normal in the V2, V3, V4 segments. Vertebrobasilar junction is normal. Basilar artery is patent. Both superior cerebellar arteries and both posterior cerebral arteries are within normal limits.
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3. Left common carotid artery arteriogram: Left common carotid artery is normal. Left external carotid artery is within normal limits. Left internal carotid artery is normal in the cervical, petrous, cavernous, ophthalmic, supraclinoid segments. The left middle cerebral artery and left anterior cerebral artery are both within normal limits.
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4. Right common carotid artery arteriogram: Right common carotid artery is normal. Right external and internal carotid arteries are within normal limits. Right middle cerebral artery and right anterior cerebral artery are both within normal limits.
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5. Right vertebral artery arteriogram: Right vertebral artery is within normal limits. V2, V3, V4 segments are within normal limits. Vertebrobasilar junction is normal.
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6. Innominate artery arteriogram: Innominate artery is within normal limits.
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7. Selective segmental arteries T4 right and left are within normal limits. T5 right and left are within normal limits. T6 right and left are within normal limits. T7 supplies the anterior spinal artery on the right side which opacified normally all the way down to the level of the conus. Left T 7 is normal. T8 right and left are within normal limits. T9 right and left are within normal limits. T10 right and left within normal limits. T11 right and left are within normal limits. T12 right and left are within normal limits. L1 right and left are within normal limits. L2 right and left are within normal limits. Right and left L3 segment artery is also within normal limits and right and left L4 segmental arteries are within normal limits. Bilateral iliac arteries are within normal limits. The right common femoral artery is within normal limits.
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Impression: Patient underwent cervical, cerebral, and spinal angiography. This study is overall within normal limits. There is no evidence of arteriovenous shunting or any vascular abnormalities.
36223,50
36226,50
75710,26
36215,59 X26
75705,26 X26
This is a cervical, cerebral, and spinal angiogram for patient with cervical cord vascular lesion. Angiogram was requested to rule out an arteriovenous malformation in the spinal cord. Consent was obtained from patient prior to procedure, patient was aware of the risks and benefits associated with the procedure. Patient agreed and consented. Patient is dialysis dependent, is scheduled to undergo hemodialysis after this procedure.
*
Patient was identified and brought to the Neuro Interventional Radiology suite, time-out was completed. Patient was prepped and draped in the usual sterile fashion. Using modified Seldinger technique, a 5 French sheath was advanced right common femoral artery. Diagnostic Sim 2 catheter was then advanced the aortic arch. I selected the left common carotid artery and the left subclavian artery with this catheter. I then selected the left vertebral artery, right common carotid artery, and the right vertebral artery and right subclavian artery with the vert catheter. Vessels were selected and multiple angiographic views were obtained from each vessel. After finishing this part, I went ahead and used a Mik diagnostic catheter to select the spinal segmental arteries. I selected all the segmental arteries from T4 all the way down to L4 segment. I also selected bilateral iliac arteries. At the end of procedure selected the right common femoral artery and did an angiographic run then closed the arteriotomy site with a Mynx device.
*
Findings: 1. Left subclavian artery arteriogram: Left subclavian artery is normal. Origin of the left vertebral artery is within normal limits.
*
2. Selective left vertebral artery arteriogram: Left vertebral artery is normal in the V2, V3, V4 segments. Vertebrobasilar junction is normal. Basilar artery is patent. Both superior cerebellar arteries and both posterior cerebral arteries are within normal limits.
*
3. Left common carotid artery arteriogram: Left common carotid artery is normal. Left external carotid artery is within normal limits. Left internal carotid artery is normal in the cervical, petrous, cavernous, ophthalmic, supraclinoid segments. The left middle cerebral artery and left anterior cerebral artery are both within normal limits.
*
4. Right common carotid artery arteriogram: Right common carotid artery is normal. Right external and internal carotid arteries are within normal limits. Right middle cerebral artery and right anterior cerebral artery are both within normal limits.
*
5. Right vertebral artery arteriogram: Right vertebral artery is within normal limits. V2, V3, V4 segments are within normal limits. Vertebrobasilar junction is normal.
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6. Innominate artery arteriogram: Innominate artery is within normal limits.
*
7. Selective segmental arteries T4 right and left are within normal limits. T5 right and left are within normal limits. T6 right and left are within normal limits. T7 supplies the anterior spinal artery on the right side which opacified normally all the way down to the level of the conus. Left T 7 is normal. T8 right and left are within normal limits. T9 right and left are within normal limits. T10 right and left within normal limits. T11 right and left are within normal limits. T12 right and left are within normal limits. L1 right and left are within normal limits. L2 right and left are within normal limits. Right and left L3 segment artery is also within normal limits and right and left L4 segmental arteries are within normal limits. Bilateral iliac arteries are within normal limits. The right common femoral artery is within normal limits.
*
Impression: Patient underwent cervical, cerebral, and spinal angiography. This study is overall within normal limits. There is no evidence of arteriovenous shunting or any vascular abnormalities.
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