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"Takeoff" of a vessel

  1. Default "Takeoff" of a vessel
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    My note states, ...Catheter was advanced to the takeoff of the left subclavian and left subclavian angiography was performed... There was narrowing of the ostium of the left vertebral and the catheter was brought up to the takeoff of this vessel to get good injections of the left vertebral artery with hand injection.....

    My question is this:

    If the documentation states "at the takeoff", is this a selective catheter placement or would it be considered non-selective?
    I know that when it is documented "at the level of" it is nonselective, but this verbage is confusing to me. I am hoping someone can help me clarify it.

    Thank you so much!

  2. #2
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    Quote Originally Posted by kcassidy View Post
    My note states, ...Catheter was advanced to the takeoff of the left subclavian and left subclavian angiography was performed... There was narrowing of the ostium of the left vertebral and the catheter was brought up to the takeoff of this vessel to get good injections of the left vertebral artery with hand injection.....

    My question is this:

    If the documentation states "at the takeoff", is this a selective catheter placement or would it be considered non-selective?
    I know that when it is documented "at the level of" it is nonselective, but this verbage is confusing to me. I am hoping someone can help me clarify it.

    Thank you so much!
    I certainly would not presume to know the thought process of this doc....but I would not translate "at" to mean "in"or "within". To me the "takeoff" is the area where the artery "takes off" from a lesser order (parent) vessel, ie "at the bifurcation" or "at the origin". Based on this documentation the highest order vessel selection is the left subclavian (36215) when he injected to evaluate the left vertebral. Also, he seem to be (to me) looking primarily at the left vertebral so the only other code I would give would be
    75685. The left subclavian was imaged (first injection) to eval the ostium (vessel origin) of the left vertebral for accessability (read guidance), and should not be separately coded IMO.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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