Subclavian angio with stent PLEASE HELP!

jmbarrera

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Can I please get assistance with the CPT codes.

Procedure performed:
Left subclavian vein angiography, angioplasty and stent

Description:
After the appropriate consent was obtained, the patient was sedated with 2 mg of versed intravenously and then 50 micrograms of fentanyl were given intravenously. Half an hour later another 50 mcg of fentanyl were administered intravenously. Local Xylocaine was given in the right groin. A 6-french sheath was placed in the right femoral artery. A pigtail catheter was used for angiography of the aortic arch that showed occlusion of the left subclavian artery. Then local Xylocaine was given in the left wrist and a 5-french sheath was placed in the left radial artery. A Vert catheter was used for the angiography of the left subclavian that showed occlusion before the bifurication into the vertebral and the main subclavian. Then an Advantage wire was used to cross the occlusion and then an angioplasty was performed with a 5x20 balloon with good results. Then a stent was deployed because there was still a residual lesion and it was a 6x27 balloon expandable stent with excellent results with no residual as confirmed by repeat left subclavian vein angiography. The right groin was closed with angio-seal. There were no complications. The patient tolerated the procedure well.

Would I code
36225
37236

or
36215
75710
37236

Do I also code the aortic arch 93567

Thank you for your help!!
 

Chlrtrep

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In this scenario

IMO I would

75710 Upper Extremity Angio
36215 Subclavian Cath Placement
37236 Stent


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36225 is for vertebral artery angiogram which was not performed
93567 is for a aorto arch angio at the time of a Left Heart or Right Heart Catheterization as is an add-on to primary procedure code.

If a true aortic(thoracic) arch angiogram was performed then CPT 36221. However this is done to visualize takeoff of the great vessels or non selective of the great vessels. I am not sure if documentation supports this charge.
 

Jim Pawloski

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Can I please get assistance with the CPT codes.

Procedure performed:
Left subclavian vein angiography, angioplasty and stent

Description:
After the appropriate consent was obtained, the patient was sedated with 2 mg of versed intravenously and then 50 micrograms of fentanyl were given intravenously. Half an hour later another 50 mcg of fentanyl were administered intravenously. Local Xylocaine was given in the right groin. A 6-french sheath was placed in the right femoral artery. A pigtail catheter was used for angiography of the aortic arch that showed occlusion of the left subclavian artery. Then local Xylocaine was given in the left wrist and a 5-french sheath was placed in the left radial artery. A Vert catheter was used for the angiography of the left subclavian that showed occlusion before the bifurication into the vertebral and the main subclavian. Then an Advantage wire was used to cross the occlusion and then an angioplasty was performed with a 5x20 balloon with good results. Then a stent was deployed because there was still a residual lesion and it was a 6x27 balloon expandable stent with excellent results with no residual as confirmed by repeat left subclavian vein angiography. The right groin was closed with angio-seal. There were no complications. The patient tolerated the procedure well.

Would I code
36225
37236

or
36215
75710
37236

Do I also code the aortic arch 93567

Thank you for your help!!

I would code 36221 for the arch, 36120 for the retrograde brachial, and 37236 for the subclavian stent. I would not code 75710 as I feel that the subclavian imaging was used as a roadmap for the stent placement.
Thanks,
Jim Pawloski, CIRCC
 
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