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carotid coding help!!!

  1. #1
    Default carotid coding help!!!
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    Indications

    Carotid stenosis, left [I65.22 (ICD-10-CM)]
    Conclusion

    This 78-year-old male was brought in for diagnostic cerebral angiogram after investigation showed severe left internal carotid artery stenosis. He was referred to vascular surgery with the deemed the patient to be a high risk for surgical approach. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 8:59 AM and monitoring period Ended 9:37 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5 French sheath was inserted in the right femoral artery. A 5 French pigtail catheter was used to perform the arch angiogram. A 5 French VTK catheter was used to selectively engage the left subclavian artery and the left common carotid artery as well as the innominate artery.
    Finding:
    1: Arch angiogram showed a type II aortic arch. There is moderate calcification at the origin of all 3 major vessels. There appears to be 50% stenosis at the origin of the left common carotid artery.
    2: The left subclavian artery is patent. There is a large patent left vertebral artery.
    3: Selective angiogram of the left common carotid artery showed patent vessel. There is 90% stenosis in the origin of the left carotid artery. Cerebral angiogram showed patent vessels.
    4: Patent innominate artery. The right subclavian artery is patent. There is a diminutive right vertebral artery. The right external iliac artery has an anomalous takeoff from the innominate artery. It has severe stenosis in its mid part. The right common carotid artery and internal carotid arteries are patent but extremely tortuous. There is normal cerebral circulation.
    *
    *
    Impression:
    1. Type II aortic arch
    2. Severe stenosis in the origin of the left internal carotid artery
    3. Patent right common and internal carotid arteries. The right external carotid artery has an anomalous takeoff from the innominate artery
    4. Left dominant vertebral system
    *
    Plan: Bring the patient back for carotid stenting of the left internal carotid artery with distal protection device
    can I code 36222 or 36225?
    thanks in advance

  2. #2
    Default
    Quote Originally Posted by bhargavi View Post
    Indications

    Carotid stenosis, left [I65.22 (ICD-10-CM)]
    Conclusion

    This 78-year-old male was brought in for diagnostic cerebral angiogram after investigation showed severe left internal carotid artery stenosis. He was referred to vascular surgery with the deemed the patient to be a high risk for surgical approach. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 8:59 AM and monitoring period Ended 9:37 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 5 French sheath was inserted in the right femoral artery. A 5 French pigtail catheter was used to perform the arch angiogram. A 5 French VTK catheter was used to selectively engage the left subclavian artery and the left common carotid artery as well as the innominate artery.
    Finding:
    1: Arch angiogram showed a type II aortic arch. There is moderate calcification at the origin of all 3 major vessels. There appears to be 50% stenosis at the origin of the left common carotid artery.
    2: The left subclavian artery is patent. There is a large patent left vertebral artery.
    3: Selective angiogram of the left common carotid artery showed patent vessel. There is 90% stenosis in the origin of the left carotid artery. Cerebral angiogram showed patent vessels.
    4: Patent innominate artery. The right subclavian artery is patent. There is a diminutive right vertebral artery. The right external iliac artery has an anomalous takeoff from the innominate artery. It has severe stenosis in its mid part. The right common carotid artery and internal carotid arteries are patent but extremely tortuous. There is normal cerebral circulation.
    *
    *
    Impression:
    1. Type II aortic arch
    2. Severe stenosis in the origin of the left internal carotid artery
    3. Patent right common and internal carotid arteries. The right external carotid artery has an anomalous takeoff from the innominate artery
    4. Left dominant vertebral system
    *
    Plan: Bring the patient back for carotid stenting of the left internal carotid artery with distal protection device
    can I code 36222 or 36225?
    thanks in advance
    You Code 36222-50 and 36225-lt. If there was more information about the cerebral vasculature, then I would code 36223 for the carotids, but it's too vague.
    HTH,
    Jim Pawloski, CIRCC

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