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36245, 75630-26

  1. #1
    Question 36245, 75630-26
    Medical Coding Books
    I am new to interventional cardiology and need help coding this scenario:

    PROTOCOL: The patient was brought to the peripheral vascular lab, was
    prepped and draped in the usual sterile fashion. Xylocaine was
    infiltrated in the left groin and left access was obtained with a 5-
    French sheath. There was a tortuosity in the iliac vessel, which was
    maneuvered with a glidewire. Subsequent exchanges were done with a
    standard J-wire. JL4/JR4 and pigtail catheters were used for
    angiography for the cardiac cath part.

    Subsequently the catheter was exchanged to a OmniFlush 5French catheter,
    which was placed at the level of L1 and an abdominal aortogram was
    performed. Subsequently catheter was pulled back up to the level of
    both bifurcations at the level of L4 and L5. Then subsequently runoff
    was performed using 80 mL of contrast in a bolus chase fashion and
    imaging was performed. After completion of the procedure the sheath was
    removed and no complications occurred.

    CARDIAC CATHETERIZATION: The cardiac catheterization will be reported
    separately under digital processing.

    VASCULAR IMAGING: The abdominal aortogram revealed presence of mild to
    moderate disease in the abdominal aorta below the diaphragm. Both renal
    arteries are small and show mild to moderate disease with no significant
    stenosis. The bifurcation appears intact with calcification and acute
    angle.

    RIGHT LOWER EXTREMITY CIRCULATION: The right common iliac artery shows
    heavy calcification and mild disease, leading up to a straighter segment
    at the level of the external iliac. The internal iliac is patent with
    no disease and subsequently the common femoral artery bifurcates
    normally at the level of the femoral head. The superficial femoral
    artery shows the proximal segment to be normal, which is followed by
    total occlusion in the upper third, which is subsequently a long
    occlusion with reconstitution of at the level of the popliteal artery
    via collaterals from the profunda and then subsequently the popliteal
    artery. Severe disease in the trifucation is noted, however, on the
    right side there is a lead take off of the anterior tibial, which is
    totally occluded proximally. The tibioperoneal trunk shows 99% stenosis
    and followed by take off of a posterior tibial artery, which looks very
    good and follows all the way to the foot and supplies the posterior arch
    without any significant disease and reconstitution of the anterior
    tibial noted above the ankle as well and so therefore at least one good
    vessel runoff is present in the right leg.

    LEFT LOWER EXTREMITY CIRCULATION: The left common iliac is tortuous and
    shows at least 40 to 50% disease at this tortuosity followed by external
    iliac artery, which reveals heavy disease and at the level of common
    femoral artery there is a 70% stenosis, which is followed by superficial
    femoral artery which is showing heavy disease up to 80 to 90% severity
    in the middle third and lower third sections. Subsequently the
    popliteal artery is relatively free of disease and followed by a severe
    trifurcation disease with almost near-total occlusion of the popliteal
    artery at the level of the anterior tibial take off. The anterior
    tibial is totally occluded. The posterior tibial artery is totally
    occluded. The peroneal artery is also totally occluded and
    reconstitutes above the ankle with both anterior tibial and posterior
    tibial arteries with slow flow into the foot.

    Would this be reported as 36245, 75630-26?

    Thanks

  2. #2
    Default
    I would code this as 36200, 75625, 75716.

    You have a high and low aortogram, in which case you would forego the 75630 and use the 75625/75716 instead.

    Very important to key on though is this small but critical mention, "CARDIAC CATHETERIZATION: The cardiac catheterization will be reported separately under digital processing."

    This tells you there was a concomitant cardiac cath performed at the same encounter as the aortogram. This is important because if the payer is Medicare, you will end up with different codes for this encounter. You'd need to investigate this further because you may have to instead report the codes for the cardiac cath, drop the 36200, and substitute G0275 and G0278 instead of 75625 and 75716 for the high and low non-selective aortogram.

    Hope this helps.
    Last edited by rpcarrillo; 05-26-2011 at 03:45 PM.
    ____________

    Rich Carrillo, CCS, CPC

  3. #3
    Default
    CATH was performed at the time of service. Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245? Would it be appropriae to append -59 mod to 36200?

  4. #4
    Default
    Quote Originally Posted by amym View Post
    CATH was performed at the time of service. Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245? Would it be appropriae to append -59 mod to 36200?
    As to the report, nothing was selected in the abdomen. So you have catheter, aorta with modifier -59.

  5. #5
    Default
    I'm sorry, just to clear it all up. I should bill:

    36200-59
    G0275
    G0278

    since cath was done same day.

  6. Default
    Quote Originally Posted by amym View Post
    I'm sorry, just to clear it all up. I should bill:

    36200-59
    G0275
    G0278

    since cath was done same day.
    In this case you should only bill G0275 and G0278 since the cardiac cath was done on the same day. CPT 36200 would bundle into the cardiac cath CPT codes, and in this specific case there would not be justification to bill 36200-59.

    Katie Goddard, CPC
    Compliance Specialist
    Mercy Health Services

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