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Visceral Arteriogram and Abdominal Aortagram

  1. #1
    Default Visceral Arteriogram and Abdominal Aortagram
    Medical Coding Books
    Good morning,

    Need a little help coding the following report. Report says later in the procedure the same catheter (the pigtail catheter) was utilized to find the origin of the the IMA but then it mentions the IMA origin was found with the Sos Omni Catheter. I was thinking of using the following codes but I'm not sure if I can claim catherization for the IMA. Only has details about aorta and it only mentions views of the SMA.

    36200
    36245-59????
    75625-26
    75726 x 2-26

    Written consent for performance of this procedure was obtained following consultation in which the risks and benefits of the procedure were discussed. The patient's supine position a micropuncture set was utilized to access the right common femoral artery below the inguinal ligament in a cleansed and anesthetized region of the right groin. With a Bentson guidewire placed into aorta from this approach the micropuncture sheath was removed and a 6 French pedicle sheath was sterilely flushed after being placed in the right iliofemoral system. It was over the Bentson guidewire that pigtail catheter was placed for a lateral arch aortogram. Later in the procedure the same catheter was utilized to find the origin of the IMA. Normal bilateral pelvicalyceal systems and ureters were identified. The SMA branches have a normal appearance although the ileocolic branch contains the ileal branches but only one small colic branch that terminates in the region of the anastomotic clips. The 2 vessels that supply the region of the hepatic flexure which are not noted to the leaking at this time directly come off the main branch of the SMA on its right side just after the takeoff of the left-sided jejunal branches. The IMA origin was found with some difficulty with the Sos Omni catheter with its origin at the level of the inferior endplate of L2. The IMA is superior hemorrhoidal branches and a large left colic branch and several small branches to the proximal rectosigmoid colon. No bleed is noted in this region. The patient tolerated the procedure well without complication and the catheters were removed with the 6 French sheath left in place with 50 cc of normal saline per our running within it.


    IMPRESSION:
    Normal SMA and IMA visceral arteriogram and limited abdominal arteriogram revealing no active bleeding within the distribution of these vessels. 185 cc of Visipaque 320 nonionic contrast agent were utilized as described above. Bleeding scan (performed 9/20/09) was positive in the region of the hepatic flexure.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by drobinson1 View Post
    Good morning,

    Need a little help coding the following report. Report says later in the procedure the same catheter (the pigtail catheter) was utilized to find the origin of the the IMA but then it mentions the IMA origin was found with the Sos Omni Catheter. I was thinking of using the following codes but I'm not sure if I can claim catherization for the IMA. Only has details about aorta and it only mentions views of the SMA.

    36200
    36245-59????
    75625-26
    75726 x 2-26

    Written consent for performance of this procedure was obtained following consultation in which the risks and benefits of the procedure were discussed. The patient's supine position a micropuncture set was utilized to access the right common femoral artery below the inguinal ligament in a cleansed and anesthetized region of the right groin. With a Bentson guidewire placed into aorta from this approach the micropuncture sheath was removed and a 6 French pedicle sheath was sterilely flushed after being placed in the right iliofemoral system. It was over the Bentson guidewire that pigtail catheter was placed for a lateral arch aortogram. Later in the procedure the same catheter was utilized to find the origin of the IMA. Normal bilateral pelvicalyceal systems and ureters were identified. The SMA branches have a normal appearance although the ileocolic branch contains the ileal branches but only one small colic branch that terminates in the region of the anastomotic clips. The 2 vessels that supply the region of the hepatic flexure which are not noted to the leaking at this time directly come off the main branch of the SMA on its right side just after the takeoff of the left-sided jejunal branches. The IMA origin was found with some difficulty with the Sos Omni catheter with its origin at the level of the inferior endplate of L2. The IMA is superior hemorrhoidal branches and a large left colic branch and several small branches to the proximal rectosigmoid colon. No bleed is noted in this region. The patient tolerated the procedure well without complication and the catheters were removed with the 6 French sheath left in place with 50 cc of normal saline per our running within it.


    IMPRESSION:
    Normal SMA and IMA visceral arteriogram and limited abdominal arteriogram revealing no active bleeding within the distribution of these vessels. 185 cc of Visipaque 320 nonionic contrast agent were utilized as described above. Bleeding scan (performed 9/20/09) was positive in the region of the hepatic flexure.

    Hmm, the documentation is too vague for me. "Finding the origin" is not the same (IMO) as selecting the artery. The origin can be "found" by injecting in the aorta. The type of catheter used does not matter for physician coding. So...
    36200/75625 is all I would code based on this document.

    HTH
    Last edited by dpeoples; 09-30-2009 at 09:16 AM. Reason: addtion
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Default
    Quote Originally Posted by dpeoples View Post
    Hmm, the documentation is too vague for me. "Finding the origin" is not the same (IMO) as selecting the artery. The origin can be "found" by injecting in the aorta. The type of catheter used does not matter for physician coding. So...
    36200/75625 is all I would code based on this document.

    HTH
    I was thinking of the same thing as you, Danny. Catheter positions were vague and what was injected?

    Thanks,
    Jim

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