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When to use 75774

  1. #1
    Question When to use 75774
    Medical Coding Books
    Good morning. I have a question about arterial catherizations. This is the report:

    Visceral arteriography from 6/5/2011

    Clinical history: Left retroperitoneal hemorrhage, probably adrenal

    Procedure findings:

    After obtaining informed consent, using Xylocaine local anesthesia and aseptic technique the right common femoral artery was punctured with a 19 gauge single wall needle and a 0.035 inch Bentson guide wire advanced into the abdominal aorta under fluoroscopic guidance. After placement of a 5-French vascular sheath, a 5 French Levin 1 and a 5-French size Omni select 2 catheter were advanced into the celiac and superior mesenteric arteries. Arteriography was performed in each location without demonstration of hypervascular tumor mass or contrast extravasation. The catheter was placed into the left renal artery and left renal arteriography was performed with reflux of the left adrenal artery after more proximal positioning; no contrast extravasation or hypervascular tumor mass was seen. The catheter and sheath were removed. Hemostasis was accomplished by manual compression. The patient left the radiology department with an intact right femoral pulse and no groin hematoma. Intravenous conscious sedation was administered as intermittent doses of Versed over a period of 60 minutes by the interventional nurse under my supervision with continuous noninvasive monitoring. Fluoroscopic and digital subtraction images on file, fluoroscopy time 15.2 minutes. 200 mL of nonionic contrast was used.

    Impression:

    No evidence of tumor blush or active contrast extravasation from celiac, superior mesenteric or left renal artery.

    Our coder used 36245x3/75726/75774/75722.

    I am questioning the use of 75774. I know it is for each additional vessel studied after the basic exam but I was thinking it was per vascular family. Or is it per code? Are you only allowed to use an arteriography code once per procedure? Woud there ever be a time you would use 75726 and 75726-59?

  2. #2
    Location
    Birmingham, Alabama
    Posts
    890
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    Quote Originally Posted by drobinson1 View Post
    Good morning. I have a question about arterial catherizations. This is the report:

    Visceral arteriography from 6/5/2011

    Clinical history: Left retroperitoneal hemorrhage, probably adrenal

    Procedure findings:

    After obtaining informed consent, using Xylocaine local anesthesia and aseptic technique the right common femoral artery was punctured with a 19 gauge single wall needle and a 0.035 inch Bentson guide wire advanced into the abdominal aorta under fluoroscopic guidance. After placement of a 5-French vascular sheath, a 5 French Levin 1 and a 5-French size Omni select 2 catheter were advanced into the celiac and superior mesenteric arteries. Arteriography was performed in each location without demonstration of hypervascular tumor mass or contrast extravasation. The catheter was placed into the left renal artery and left renal arteriography was performed with reflux of the left adrenal artery after more proximal positioning; no contrast extravasation or hypervascular tumor mass was seen. The catheter and sheath were removed. Hemostasis was accomplished by manual compression. The patient left the radiology department with an intact right femoral pulse and no groin hematoma. Intravenous conscious sedation was administered as intermittent doses of Versed over a period of 60 minutes by the interventional nurse under my supervision with continuous noninvasive monitoring. Fluoroscopic and digital subtraction images on file, fluoroscopy time 15.2 minutes. 200 mL of nonionic contrast was used.

    Impression:

    No evidence of tumor blush or active contrast extravasation from celiac, superior mesenteric or left renal artery.

    Our coder used 36245x3/75726/75774/75722.

    I am questioning the use of 75774. I know it is for each additional vessel studied after the basic exam but I was thinking it was per vascular family. Or is it per code? Are you only allowed to use an arteriography code once per procedure? Woud there ever be a time you would use 75726 and 75726-59?
    My code selections would be:
    36245 75726 SMA
    36245 (59or76) 75726-(59 or 76 depending on payor)Celiac
    36245 75722 LT renal

    I will assume the coder used 75774 for the injection of SMA thinking that was a further selection (hence 75774) of the celiac. The SMA is a different vascular family from the aorta (in normal anatomy) therefore another basic exam (75726) was performed.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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