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Thread: Bilateral Carotid Arteriogram

  1. #1

    Question Bilateral Carotid Arteriogram

    AAPC: Back to School
    Please help with coding!

    Procedure Performed:
    1. Thoracic aortic arch aortogram.
    2. Bilateral selective carotid arteriogram.
    3. Intracranial angiography.

    Indication: Mr. Salmon presented with symptoms of dizziness without
    known coronary artery disease with history of stents and noninvasive
    imaging revealed high-grade stenosis of the left carotid artery with
    CT angiography. However the degree of stenosis was not certain on
    the CT angiography.

    Protocol: The patient was brought to the cath laboratory. Right
    groin was prepped and draped in the usual sterile fashion.
    Xylocaine was infiltrated. A 5-French sheath was inserted without
    difficulty and subsequently a 5-French pigtail catheter was advanced
    and positioned in the ascending aorta. Thoracic aortogram was
    performed subsequent to which the catheter is removed and then a
    Headhunter catheter was advanced. The right brachiocephalic artery
    was cannulated however the catheter was selected into the
    brachiocephalic artery but could not be advanced into the right
    carotid artery. The left carotid artery was cannulated selectively.
    In both locations carotid as well as intracranial angiography was
    performed. Total contrast used was 160 mL. No complications
    occurred. The sheath was removed after the procedure was completed.

    Findings: The aortogram revealed presence of normal-appearing
    ascending arch and descending aorta with normal takeoff of the great
    vessels. This appears to be a type 1 arch and the Headhunter
    catheter was placed selectively in the right brachiocephalic artery.
    The origin of the artery appears to be normal. The takeoff of the
    carotid artery, common carotid artery, and the bulb area all
    appeared to be normal. There is only mild, less than 20% plaque
    noted and the external carotid artery is intact. The extracranial
    portion of the carotid artery appears to be normal as well.

    The right-sided intracranial circulation has less than optimal
    visualization however appears to be intact with no definite lesions
    identified. However there was some motion artifact as well as
    suboptimal filling of the vessel and therefore may result in
    accurately compromised.

    The left carotid artery appears to show normal common carotid
    artery, and the takeoff is preserved. The external carotid artery
    is without any significant disease.

    Internal carotid artery on the left side demonstrates an apple-core
    lesion which appears to be at least 70 to 80% in severity. The
    distal portion of the internal carotid artery as well as the
    extracranial course appears to be without any significant disease.

    The left intracranial angiography is selective and with good
    excellent images and appears to have normal-appearing vessels
    throughout the middle and anterior cerebral arteries with normal
    venous phase.


    1. The left internal carotid artery with 70 to 80% stenosis.
    2. The right intracranial visualization was suboptimal.
    3. Mild plaque on the right internal carotid artery.

  2. #2
    Join Date
    Apr 2007
    Alexandria, LA


    36215 (right brachiocephalic catheterization)
    36215-59 (left common carotid catheterization
    75650 - arch
    75671 - bilateral cerebral carotid angiography
    75680 - bilateral cervical carotid angiography

  3. #3
    Join Date
    Apr 2007
    durham, nc


    Donna has it right, that is the way I would code this too
    A.Dimmitt, CPC, CIRCC
    Durham, North Carolina

  4. #4
    Join Date
    Apr 2007
    Birmingham, Alabama


    Quote Originally Posted by donnajrichmond View Post
    36215 (right brachiocephalic catheterization)
    36215-59 (left common carotid catheterization
    75650 - arch
    75671 - bilateral cerebral carotid angiography
    75680 - bilateral cervical carotid angiography
    I agree with these codes.
    Danny L. Peoples

  5. #5


    Thanks all

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