# 36245, 75630-26



## amym (May 26, 2011)

I am new to interventional cardiology and need help coding this scenario:

PROTOCOL:  The patient was brought to the peripheral vascular lab, was 
prepped and draped in the usual sterile fashion.  Xylocaine was 
infiltrated in the left groin and left access was obtained with a 5- 
French sheath.  There was a tortuosity in the iliac vessel, which was 
maneuvered with a glidewire.  Subsequent exchanges were done with a 
standard J-wire.  JL4/JR4 and pigtail catheters were used for 
angiography for the cardiac cath part. 

Subsequently the catheter was exchanged to a OmniFlush 5French catheter, 
which was placed at the level of L1 and an abdominal aortogram was 
performed.  Subsequently catheter was pulled back up to the level of 
both bifurcations at the level of L4 and L5.  Then subsequently runoff 
was performed using 80 mL of contrast in a bolus chase fashion and 
imaging was performed.  After completion of the procedure the sheath was 
removed and no complications occurred. 

CARDIAC CATHETERIZATION:  The cardiac catheterization will be reported 
separately under digital processing. 

VASCULAR IMAGING:  The abdominal aortogram revealed presence of mild to 
moderate disease in the abdominal aorta below the diaphragm.  Both renal 
arteries are small and show mild to moderate disease with no significant 
stenosis.  The bifurcation appears intact with calcification and acute 
angle. 

RIGHT LOWER EXTREMITY CIRCULATION:  The right common iliac artery shows 
heavy calcification and mild disease, leading up to a straighter segment 
at the level of the external iliac.  The internal iliac is patent with 
no disease and subsequently the common femoral artery bifurcates 
normally at the level of the femoral head.  The superficial femoral 
artery shows the proximal segment to be normal, which is followed by 
total occlusion in the upper third, which is subsequently a long 
occlusion with reconstitution of at the level of the popliteal artery 
via collaterals from the profunda and then subsequently the popliteal 
artery.  Severe disease in the trifucation is noted, however, on the 
right side there is a lead take off of the anterior tibial, which is 
totally occluded proximally.  The tibioperoneal trunk shows 99% stenosis 
and followed by take off of a posterior tibial artery, which looks very 
good and follows all the way to the foot and supplies the posterior arch 
without any significant disease and reconstitution of the anterior 
tibial noted above the ankle as well and so therefore at least one good 
vessel runoff is present in the right leg. 

LEFT LOWER EXTREMITY CIRCULATION:  The left common iliac is tortuous and 
shows at least 40 to 50% disease at this tortuosity followed by external 
iliac artery, which reveals heavy disease and at the level of common 
femoral artery there is a 70% stenosis, which is followed by superficial 
femoral artery which is showing heavy disease up to 80 to 90% severity 
in the middle third and lower third sections.  Subsequently the 
popliteal artery is relatively free of disease and followed by a severe 
trifurcation disease with almost near-total occlusion of the popliteal 
artery at the level of the anterior tibial take off.  The anterior 
tibial is totally occluded.  The posterior tibial artery is totally 
occluded.  The peroneal artery is also totally occluded and 
reconstitutes above the ankle with both anterior tibial and posterior 
tibial arteries with slow flow into the foot. 

Would this be reported as 36245, 75630-26?

Thanks


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## rpcarrillo (May 26, 2011)

I would code this as 36200, 75625, 75716.

You have a high and low aortogram, in which case you would forego the 75630 and use the 75625/75716 instead.

*Very important to key on though* is this small but critical mention, "CARDIAC CATHETERIZATION: The cardiac catheterization will be reported separately under digital processing."

This tells you there was a concomitant cardiac cath performed at the same encounter as the aortogram. This is important because if the payer is Medicare, you will end up with different codes for this encounter. You'd need to investigate this further because you may have to instead report the codes for the cardiac cath, drop the 36200, and substitute G0275 and G0278 instead of 75625 and 75716 for the high and low non-selective aortogram.

Hope this helps.


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## amym (May 31, 2011)

CATH was performed at the time of service.  Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245?  Would it be appropriae to append -59 mod to 36200?


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## Jim Pawloski (May 31, 2011)

amym said:


> CATH was performed at the time of service.  Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245?  Would it be appropriae to append -59 mod to 36200?



As to the report, nothing was selected in the abdomen. So you have catheter, aorta with modifier -59.


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## amym (Jun 1, 2011)

I'm sorry, just to clear it all up.  I should bill:

36200-59
G0275
G0278

since cath was done same day.


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## kgodda1 (Jun 1, 2011)

amym said:


> I'm sorry, just to clear it all up.  I should bill:
> 
> 36200-59
> G0275
> ...



In this case you should only bill G0275 and G0278 since the cardiac cath was done on the same day.  CPT 36200 would bundle into the cardiac cath CPT codes, and in this specific case there would not be justification to bill 36200-59.

Katie Goddard, CPC
Compliance Specialist
Mercy Health Services


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