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Aortogram - confirm my codes

  1. Default Aortogram - confirm my codes
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    Can anyone please confirm my codes for the below pocedure

    Patient is a 60-year-old male with COPD exacerbation, intubated.
    He now presents with massive hemoptysis, a witnessed episode of at
    least 800 cc

    The patient's right groin was prepped and draped in usual sterile
    manner and locally anesthetized with 1% lidocaine. The right
    common femoral artery was accessed with a micro-puncture site,
    exchange made for a 6 French vascular sheath. A 5 French Omni
    Flush catheter was advanced into the aortic arch. Digital
    subtraction aortography was performed in 45? left anterior oblique

    A Simmons 2 catheter was reformed over the aortic arch and used to
    selectively catheterize the left subclavian artery. Digital
    subtraction angiography was performed with injection into the left
    subclavian artery.

    Due to inability to identify any potential bleeding or abnormal
    vessel, repeat aortography was performed this time with the
    catheter in the descending thoracic aorta. The right-sided
    intercostal bronchial trunk was identified, and selective
    catheterization was performed using a 5 French Cobra catheter.

    Exchange was then made for a Mickelson catheter and selective
    catheterization was performed of multiple intercostal arteries
    with contrast injection.

    All of the visualized injected vessels are unremarkable. Aortic
    arch and descending thoracic aorta injection reveals no abnormal
    area of hypervascularity in either lung field. The internal
    mammary arteries are identified bilaterally, and are unremarkable
    in appearance. Injection of the right intercostal bronchial trunk
    is unremarkable as well, the vessel is not hypertrophied and this
    does not appear to be a bleeding source. Numerous other
    intercostal arteries were injected, also unremarkable in

    At the end of the procedure the catheter and sheath were removed
    and hemostasis achieved with manual compression. No embolization
    was performed, due to inability to find any abnormal, possibly
    bleeding vessel.

    Arch aortagram, descending thoracic aortogram, left subclavian
    artery arteriogram, as well as selective injections into the
    intercostobronchial trunk and multiple intercostal arteries are
    all unremarkable. No area of hypervascularity is identified and no
    embolization was performed.
    Prabha CPC

  2. #2
    Default Slg
    I did not check all of your codes, but there are a few things that stand out when reading the note. I noticed the phrase "All of the visualized injected vessels are unremarkable". I feel the vessels in particular that are being referred to should be listed.

    I also did not see an interpretation for the Subclavian specifically.

    How did you arrive at 75706 X 6 ?

  3. Default Chest vs spine case

    I would have coded 75726 instead of 76705. The patient has hempotysis not an issue with their spine. 75726 would be the correct code in a chest case

  4. Default cath placements
    I would be leary to code that many cath placements when the physician is not being clear on the number of intercostals he selectively engaged. That also will play part in how many angios (75726) you bill. (I agree with everyone's comments on the 75706 should be 75726)

  5. #5
    Default Aortogram, new at this
    Could an Aortogram be done with selective catheterization?

  6. #6
    Quote Originally Posted by fredcpc View Post
    Could an Aortogram be done with selective catheterization?
    Depends on what vessels were selected. The aortic arch can be billed w/ selective carotids/ vertebrals, but not in the abdomen where they are bundled.

    Jim Pawloski, CIRCC

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