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Interventional cardiology coding

  1. #1
    Lightbulb Interventional cardiology coding
    Medical Coding Books
    Please help coding this scenario:

    1. Abdominal aortogram with bilateral lower extremity runoff.
    2. Carotid arteriogram, selective.
    3. Laser atherectomy followed by percutaneous transluminal angioplasty
    of the left superficial femoral artery.

    CLINICAL SUMMARY: The patient is a pleasant 68-year-old white female
    who presented with symptoms of claudication bilaterally. Lately she has
    experienced episodes of dizziness and spells, which required her to be
    hospitalized at one time.

    PROTOCOL: The patient was brought to the cath lab. Both groins were
    prepped and draped in the usual sterile fashion. Xylocaine was
    infiltrated for right femoral artery access with a single stick and a 5-
    French sheath inserted. A 5-French OmniFlush catheter was advanced and
    an abdominal angiogram was performed followed by runoff using 80 mL of
    contrast, as well as chase method. No complications occurred.

    ABDOMINAL AORTOGRAM: The abdominal aorta shows good caliber with mild
    atherosclerosis. Bilateral and multiple renal arteries are patent but
    showing moderate disease. Mesenteric artery shows proximal disease with
    calcification and may be of interest, if patient has symptoms of
    postprandial abdominal symptoms. However, the severity of this lesion
    was not carefully assessed. The bifurcation is intact with no
    significant disease involving the bifurcation.

    RIGHT LOWER EXTREMITY ARTERIOGRAM: The right circulation reveals the
    following: The right common iliac artery has a 60 to 70% narrowing at
    the very proximal part, which is showing evidence of ulceration. The
    right common iliac leads up to patent external and internal iliac
    arteries. The extremely big artery shows heavy disease up to 50%
    severity leading up to the bifuraction and the profunda and superficial
    femoral artery. The superficial femoral artery in the proximal third
    shows very severe disease up to 90 to 95% severity. The middle and
    distal third of the superficial femoral artery reveals moderate-heavy
    disease with up to 60 to 70% lesions and multiple 60% lesions in
    multiple places leading up to the popliteal artery, which is patent and
    leads to the trifucation. The trifurcation reveals moderate disease
    with patency of all three vessels of the anterior tibial, posterior
    tibial and peroneal arteries are patent with three-vessel runoff to the
    distal leg.

    LEFT LOWER EXTREMITY ARTERIOGRAM: The left circulation reveals the
    following: The left common iliac artery shows mild to moderate
    atherosclerosis diffusely but large caliber with at least external iliac
    artery, which shows 50 to 60% heavy plaque with eccentric and tortuous
    vessel leading to bifurcation. The superficial femoral artery reveals
    aggressive severe disease extending from the proximal part all the way
    to the popliteal with up to 90% stenosis in 2 or 3 spots. The popliteal
    artery is relatively free of any disease and leads up to a trifucation,
    which is showing patent anterior tibial, posterior tibial and peroneal
    vessels with flow into the foot without any significant disease.

    I think it should be coded as followed:

    1. 36245, 75630-26 - Abdominal aortogram with bilateral lower extremity runoff.
    2. 36216 - Carotid arteriogram, selective.
    3. 37225 - Laser atherectomy followed by percutaneous transluminal angioplasty
    of the left superficial femoral artery.

    I may be way off but would really appreciate your help!

  2. #2
    Phoenix, AZ
    Your codes should be - 75630-26 + 36200. You cannot code the 36216 as the catheter did not enter either carotid.

    I'm not sure about the atherectomy because you didn't include the note. However, if the provider did an atherectomy, you may only code the 37225.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
    Sorry, this is the rest of the note!

    CAROTID ARTERIOGRAM: Carotid arteriogram was performed using the
    pigtail catheter to perform the left arteriogram, which visualized the
    arch and the great vessels, which appear to takeoff normally.

    SELECTIVE CAROTID ANGIOGRAPHY: The selective angiography of the right
    and left carotid arteries was performed using a Headhunter catheter for
    the right and JL4 French catheter was the left. Imaging was done in
    various angles and intracranial imaging was not performed.

    FINDINGS: Reveal the right carotid shows evidence of 60% plaque, which
    is somewhat eccentric but excellent flow was noted into distal
    circulation. The left common carotid artery shows a widely patent lumen
    with no only mild atherosclerosis. The external carotid artery shows
    ostial disease of 70% of severity.

    After the lesion was identified, it was felt the laser approach would be
    optimal due to the diffuse disease. At this point, the 6-French
    Destination sheath was advanced and placed in the contralateral common
    femoral artery. An 0.14 Sparta-Core guidewire was then advanced and
    taken across the lesion and then positioned in the left popliteal artery
    and then laser atherectomy was performed using 1.4 mm fiber and two
    passes were done throughout the entire superficial femoral artery and
    subsequently the 300 length 3 mm VascuTrac balloon was then advanced and
    positioned across the distal part of the superficial femoral artery and
    then pulled back covering the entire proximal part of the superficial
    femoral artery and multiple dilatations were performed. Marked
    improvement was noted and there was no evidence of dissection and
    excellent flow was present with subsequent runoff was seen in the lower
    leg as well, which confirmed improvement. At this point, the entire
    assembly was removed from the left superficial femoral artery, then
    multiple images were performed to ensure the flow was visualized well
    from the left external iliac artery.

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