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Cath report

  1. Question Cath report
    Medical Coding Books
    Good day,

    I do not normally code cath reports,so one can only imagine how lost I am. Can you please offer any assistance? How would you code this report and can you include your justification for the codes you selected & highlight where? You have no idea how much I appreciate this.

    Vessel Angiography Findings
    AORTOGRAM:
    Focal aneurysm distal aorta just proximal to aortic bifurcation
    50% calcified focal stenosis left common iliac artery

    LEFT LOWER EXTREMITY ANGIOGRAPHY:1
    00% ostial occlusion previously stented left SFA with reconstitution at the distal SFA via collaterals from the profunda femoris
    Patent popliteal-distal bypass which is anastomosed to the distal AT
    100% occlusion of native PT, peroneal and AT proximally with reconstitution of distal AT via pop-distal bypass
    1 vessel run off to the foot as described

    RIGHT LOWER EXTREMITY ANGIOGRAPHY:
    100% occlusion mid segment of previously stented SFA with reconstitution of the distal SFA via collaterals from the profunda femoris
    100% occlusion proximal AT and PT with reconstitution of AT at the ankle via collaterals from the peroneal artery
    1 vessel run-off via peroneal artery to the foot

    Interventional Procedure Details:
    Pt was prepped and draped in sterile fashion followed by injection of lidocaine to anesthetize the tissues of the left groin. Access was gained in the common femoral artery on the left and a 4F Brite Tip Sheath was placed. Aortogram with run-off was performed using a 4F UF catheter positioned in the distal aorta. The catheter was then advanced over a guidewire to the contralateral SFA and right lower extremity angiography was then performed. The 4F sheath was exchanged for a 6F 70 cm Cook Ansel Sheath which was positioned with the distal tip in the right common femoral artery. A VIPER wire was advanced into the peroneal artery and orbital atherectomy was performed using a 1.5 Classic Crown Diamondback device in the proximal SFA. The SFA was then dilated using 6.0 mm x 150 mm SAVVY and 6.0 x 40 mm ANGIOSCULPT balloons serially. Flow limiting dissection was noted in areas of the distal and mid and proximal SFA requiring the placement of a 9 mm x 40 PRECISE and 8 x 120 SMART 2, 9x30 mm SMART stent from distal to proximal and post dilated using a 6.0x15mm AVIATOR balloon. Final angiography revealed absence of flow in the single run-off vessel requiring mechanical thrombectomy of the peroneal artery using a PRONTO V3 aspiration device. Final angiograply revealed improved flow through the SFA and peroneal.
    Last edited by coders_rock!; 01-20-2012 at 02:25 PM.

  2. #2
    Location
    Salt Lake City
    Posts
    841
    Default
    Quote Originally Posted by coders_rock! View Post
    Good day,

    I do not normally code cath reports,so one can only imagine how lost I am. Can you please offer any assistance? How would you code this report and can you include your justification for the codes you selected & highlight where? You have no idea how much I appreciate this.

    Vessel Angiography Findings
    AORTOGRAM:
    Focal aneurysm distal aorta just proximal to aortic bifurcation
    50% calcified focal stenosis left common iliac artery

    LEFT LOWER EXTREMITY ANGIOGRAPHY:1
    00% ostial occlusion previously stented left SFA with reconstitution at the distal SFA via collaterals from the profunda femoris
    Patent popliteal-distal bypass which is anastomosed to the distal AT
    100% occlusion of native PT, peroneal and AT proximally with reconstitution of distal AT via pop-distal bypass
    1 vessel run off to the foot as described

    RIGHT LOWER EXTREMITY ANGIOGRAPHY:
    100% occlusion mid segment of previously stented SFA with reconstitution of the distal SFA via collaterals from the profunda femoris
    100% occlusion proximal AT and PT with reconstitution of AT at the ankle via collaterals from the peroneal artery
    1 vessel run-off via peroneal artery to the foot

    Interventional Procedure Details:
    Pt was prepped and draped in sterile fashion followed by injection of lidocaine to anesthetize the tissues of the left groin. Access was gained in the common femoral artery on the left and a 4F Brite Tip Sheath was placed. Aortogram with run-off was performed using a 4F UF catheter positioned in the distal aorta. The catheter was then advanced over a guidewire to the contralateral SFA and right lower extremity angiography was then performed. The 4F sheath was exchanged for a 6F 70 cm Cook Ansel Sheath which was positioned with the distal tip in the right common femoral artery. A VIPER wire was advanced into the peroneal artery and orbital atherectomy was performed using a 1.5 Classic Crown Diamondback device in the proximal SFA. The SFA was then dilated using 6.0 mm x 150 mm SAVVY and 6.0 x 40 mm ANGIOSCULPT balloons serially. Flow limiting dissection was noted in areas of the distal and mid and proximal SFA requiring the placement of a 9 mm x 40 PRECISE and 8 x 120 SMART 2, 9x30 mm SMART stent from distal to proximal and post dilated using a 6.0x15mm AVIATOR balloon. Final angiography revealed absence of flow in the single run-off vessel requiring mechanical thrombectomy of the peroneal artery using a PRONTO V3 aspiration device. Final angiograply revealed improved flow through the SFA and peroneal.
    37227 Stent and Atherectomy
    37186 secondary mechanical thrombectomy because it is secondary to primary procedure 37227
    75635-26 aortagram with run off
    75898-26 follow up angio
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Default
    Quote Originally Posted by coders_rock! View Post
    Good day,

    I do not normally code cath reports,so one can only imagine how lost I am. Can you please offer any assistance? How would you code this report and can you include your justification for the codes you selected & highlight where? You have no idea how much I appreciate this.

    Vessel Angiography Findings
    AORTOGRAM:
    Focal aneurysm distal aorta just proximal to aortic bifurcation
    50% calcified focal stenosis left common iliac artery

    LEFT LOWER EXTREMITY ANGIOGRAPHY:1
    00% ostial occlusion previously stented left SFA with reconstitution at the distal SFA via collaterals from the profunda femoris
    Patent popliteal-distal bypass which is anastomosed to the distal AT
    100% occlusion of native PT, peroneal and AT proximally with reconstitution of distal AT via pop-distal bypass
    1 vessel run off to the foot as described

    RIGHT LOWER EXTREMITY ANGIOGRAPHY:
    100% occlusion mid segment of previously stented SFA with reconstitution of the distal SFA via collaterals from the profunda femoris
    100% occlusion proximal AT and PT with reconstitution of AT at the ankle via collaterals from the peroneal artery
    1 vessel run-off via peroneal artery to the foot

    Interventional Procedure Details:
    Pt was prepped and draped in sterile fashion followed by injection of lidocaine to anesthetize the tissues of the left groin. Access was gained in the common femoral artery on the left and a 4F Brite Tip Sheath was placed. Aortogram with run-off was performed using a 4F UF catheter positioned in the distal aorta. The catheter was then advanced over a guidewire to the contralateral SFA and right lower extremity angiography was then performed. The 4F sheath was exchanged for a 6F 70 cm Cook Ansel Sheath which was positioned with the distal tip in the right common femoral artery. A VIPER wire was advanced into the peroneal artery and orbital atherectomy was performed using a 1.5 Classic Crown Diamondback device in the proximal SFA. The SFA was then dilated using 6.0 mm x 150 mm SAVVY and 6.0 x 40 mm ANGIOSCULPT balloons serially. Flow limiting dissection was noted in areas of the distal and mid and proximal SFA requiring the placement of a 9 mm x 40 PRECISE and 8 x 120 SMART 2, 9x30 mm SMART stent from distal to proximal and post dilated using a 6.0x15mm AVIATOR balloon. Final angiography revealed absence of flow in the single run-off vessel requiring mechanical thrombectomy of the peroneal artery using a PRONTO V3 aspiration device. Final angiograply revealed improved flow through the SFA and peroneal.
    75716 - Bilateral lower extremity angio. Catheter was placed in distal aorta, no mention of renal arteries, so no abd. aortogram.
    37227 - Stent placement w/ atherectomy; fem-pop region.
    37186 - Secondary Thrombectomy- "rescue" of suction thrombectomy in chasing a clot.

    HTH,
    Jim Pawloski, CIRCC

  4. #4
    Location
    Alexandria, LA
    Posts
    518
    Default
    Hmmm, I wonder how many different opinions we can get?
    I get 75716 -59(bilateral extremities from distal aorta)
    75774-59 (additional imaging on the right after moving the catheter to the SFA)
    37227 - atherectomy, stent, angioplasty in SFA
    37186 - rescue mechanical thrombectomy in peroneal artery

    (75635 is a CTA, not a "regular" angiogram, so that can't be coded. Although the doctor said he did an aortogram with run-off, he was at the distal aorta, so he didn't really do an aortogram.
    75898 can only be coded after thrombolysis or embolization. Follow-up angiography is already included in thrombectomy, atherectomy, stent, and angioplasty.)

  5. Default
    Thank you all for responding. I understand billing 37227 and 37186,however, can you ellaborate on 75716-isn't this bundled to 37227 & 37186. The same goes for 75774.

    I await your response.

  6. #6
    Default
    Quote Originally Posted by coders_rock! View Post
    Thank you all for responding. I understand billing 37227 and 37186,however, can you ellaborate on 75716-isn't this bundled to 37227 & 37186. The same goes for 75774.

    I await your response.
    You had at the beginning a diagnostic angio. before the intervention. So that can be billed, but you have to have the -59 modifier to show the peripheral as a separate procedure. I didn't bill the 75774, because I thought of the injection into the SFA was a guiding shot for the intervention. But to answer the second part of your question, if the catheter is moved more selectively in a vascular family, and imaging is performed, then you can bill 75774 for additional imaging after the basic. My best example is when the Celiac artery is selected and injected, then the catheter is moved into the hepatic artery and injected. The Celiac injected gets the visceral charge, and the hepatic artery get the add-on code.
    HTH,
    Jim Pawloski

  7. Default
    Thanks Jim, your advice and donna's was extremely helpful.

  8. #8
    Location
    Alexandria, LA
    Posts
    518
    Default
    Quote Originally Posted by Jim Pawloski View Post
    You had at the beginning a diagnostic angio. before the intervention. So that can be billed, but you have to have the -59 modifier to show the peripheral as a separate procedure. I didn't bill the 75774, because I thought of the injection into the SFA was a guiding shot for the intervention. But to answer the second part of your question, if the catheter is moved more selectively in a vascular family, and imaging is performed, then you can bill 75774 for additional imaging after the basic. My best example is when the Celiac artery is selected and injected, then the catheter is moved into the hepatic artery and injected. The Celiac injected gets the visceral charge, and the hepatic artery get the add-on code.
    HTH,
    Jim Pawloski
    I agree that there should be better documentation for that additional imaging to indicate whether it was diagnostic or roadmapping.

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