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Angioplasty code when combined with other procedures

  1. Default Angioplasty code when combined with other procedures
    Medical Coding Books
    Would someone be able to help with this coding? I am newly certified and new to coding and there is no previous files I can look back to for this case.
    Bilateral femoral artery exposure with placement of wires and sheaths into the iliac arteris bilaterally - 34812-50 & 36200-50
    Endograft stent repair of abdominal aortic aneurysm - 34802
    Completion aortogram with interpretation - 75630-26 (?)
    Angioplasty of right external iliac artery - can this be billed separately? 37220 with a modifier?
    Repair of bilateral femoral arteriotomies - included in 34812

    Without retyping the entire op report and I am hoping this portion is the information someone needs to help me.

    We completed the deployment of the device with two or more extensions on the right side down into the distal right common iliac artery and then a 20 mm cuff extension to just above the difurcation of the right iliac artery to completely seal off the aneurysm distally. At this point the Medtronic balloon was now used to dilate all seal zones and contact zones and then a completion aortogram was done. This showed excellent sealing distally at the iliac level with good flow through the bifurcation of the iliac arteries. The renal arteries were widely patent. The accessory renal artery was no longer evident. There was a small blush at the very midportion of the main body. I did not feel that this was a type 1 endoleak and was concerned that this was a porosity endoleak type 4. I did re-balloon the very proximal portion of the stent graft at the renal artery level two more times and along the gate region again. Further dye was placed and it showed that this blush has improved but was still there. I did not feel that clinically this was a type 1 endoleak. The top of the graft appeared to be stable and therefore we would reverse the heparin at this time and my decision would be to recheck the CT scan in 1 month. There was some lumbar fill noted also with evidence of type 2 endoleaks. No other evidence of type 1 endo leaks were noted. The graft was very stable. I removed the guidewires from the left side. I did place a 6 mm balloon into the right proximal external iliac artery where there was a narrowing there and I insufflated this balloon for this stenosis of the proximal right external iliac artery. At completion I did place some dye through the sheath at that level and the stenosis was completely resolved with this insufflation of the 6 mm balloon catheter. This was now removed. Clamps were placed on the femoral vessels and then I repaired the arteriotomies with running 5-0 sutures...


  2. #2
    Smile My opinion
    I'm not 100% certain, since I did not see the entire op note, but here is my opinion. I would not bill for the completion angiogram, 75630, as this is usually included in the procedures performed. I would bill the 37220 for the external iliac angioplasty since it was due to a recorded stenosis . The other codes appear to be correct from what I can see. Hope this helps!
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

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