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Intra-op Diagnostic angiograms- Long report!

  1. #1
    Default Intra-op Diagnostic angiograms- Long report!
    Medical Coding Books
    Need help with the diagnostic angiograms. Surgeon wants to bill 35495, 36247,36248 x4,75630, 75774x4, 75952

    Can someone help me with the following scenario.

    Here is the entire note: thought I would post this so you could see the entire thing.

    Percutaneous entry of the femoral artery was accomplished. A guidewire and sheath were inserted. A retrograde aortogram was done and showed the aortic bifurcation so that the catheter could be passed over the bifurcation and down into the external iliac on the left side. Angiography here demostrated the femoral bifurcation, and the catheter was led into the superficial femoral artery. At this point, the sheath was exchanged over an Amplatz wire. The catheter was passed down into the popliteal artery, and good angiography was done below the knee, demonstrating occlusion of all 3 tibial vessels. The wire was first led into the posterior tibial artery and the catheter advanced into the posterior tibial artery. Selective angiography here demonstrated the area of occlusion to be approximately 6cm long.

    At this point, the wire was exchanged for a Grand Slam wire, and the crosser device was used to start to get across the occluded segment. This was used in the routine manner. I was able to get completely across and into the distal posterior tibial artery. The wire was left distally and exchanged for the Viper wire. An orbital atherectomy catheter was then used to open the occluded segment, and follow-up angiography showed a very nice result.

    At this point, the catheter was passed into the anterior tibial artery. An attempt was made to get down the anterior tibial artery using the Crosser device. This was not able to be accomplished. We perforated the vessel and I could no longer get through. The attempt was abandoned.

    The catheter was then passed into the peroneal artery so that we could get selective angiographies of all 3 tibial vessels. The wire was, again, attempted to be passed down the peroneal artery; however, again we were unable to get through the mid to distal ends. The procedure was then abandoned.
    Hemostasis was secured using the Proglide technique. Sterile dressings were applied. The patient was taken to the recovery room in satisfactory condition, having tolerated the procedure well.


  2. #2
    I agree with the 75992/35495. I'm not sold on the 75630 though. That code includes abdominal aortogram and bilateral lower extremities, I don't see clear documentation of both lower extremities being visualized, just the bifurcation. I was leaning more towards a 75625 (aortogram), 75710, 75774x4 (popliteal, PTA, ATA, and PA), 36247 (posterior tibial), and 36248x2 (anterior tibial and peroneal)

  3. #3
    I don't agree with 75630. In fact he always uses that code and I don't agree(which I have told him)
    Thank you for clarifying with 75774.
    I would use 75625, 75710 and then I was unsure how many 75774's I could bill.

    Does 75710 end at the SFA, and any further angios after that can be billed with 75774.

  4. #4
    I'm not sure that there's really any rule as to how far down the leg you need to go to use an each additional code (75774), the cpt states "Angiography, selective, each additional vessel studied after basic examination". The Interventional Radiology Coder states: "Use this code (75774) only when there is true need for additional diagnostic imaging after the basic/primary study." Documentation must support it.

    hope that helps!

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