# Need Help!! Upper extremity angiogram



## sandya (Oct 23, 2014)

Hi...I have no idea how to code the following:
Sheath inserted in the right femoral artery, pigtail cath was inserted into the descending aorta.  selective subclavian angio was done, he then crossed through the proximal vessel stenosis to the mid subclavian artery, using the same cath.  Angio:  the ascending, transverse, and descending thoracic aorta all appear normal, the 3 great vessels were identified, innominate/subclavian on the right, the left common carotid, proximal portion of the ICA, external carotid, right subclavian,left subclavian, so he looked at all of that, servere stenosis in the left internal carotid, moderate stenosis of the right internal carotid, mild disease of the left subclavian.  How do I code all the this??  thanks  Sandy


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## lkfloyd (Oct 23, 2014)

I would have to see the actual op-report to help, you have mentioned several vessels that could be reported, but these are codes based on hierarchies (36215 through 36228) and knowing where the cath was advanced to would dictate what codes to look at.


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## sandya (Oct 23, 2014)

*Upper Extremity Angiogram-HELP!!*

Hi... this is the report:

A 6-French sheath was inserted in the right femoral artery.  Over a Bentson wire a pigtail catheter was inserted into the descending aorta. Thoracic aortography was performed from an LAO projection.  This catheter was then exchanged out for a 5-French JR 4 catheter. Selective left subclavian angiography was performed also from an LAO projection. I been crossed through the proximal vessel stenosis to the mid subclavian artery using the same 5 JR 4 catheter. Pressure transducer was attached and there was a catheter pullback performed from the subclavian to the central aortic circulation

 Angiography: The ascending, transverse, and descending thoracic aorta all appear grossly normal without evidence of dissection or aneurysm.  The 3 great vessels were identified. There is tortuosity noted in the innominate/subclavian on the right.   The left Common carotid is tortuous.  There is a severe stenosis of 70-80% severity in the proximal portion of the ICA. The external carotid has what appears to be moderate stenosis. The right subclavian has what appears to be a posterior origin. The mid segment has what appears to be mild to moderate stenosis. Over a wire then inserted a 5 JR 4 catheter into the left subclavian. Selective angiography was performed from LAO cranial projection. There is adequate reflux into the descending aorta in this vessel has only mild to moderate nonocclusive disease. On catheter pull back there was no significant pressure gradient between the subclavian and the aorta.

 Right iliofemoral angiogram was performed through the sheath from an RAO projection. The sheath was in an adequate location in the artery was suitable. A 6-French Angio-Seal was deployed at the site and adequate hemostasis was confirmed.
 thanks, Sandy


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## jewlz0879 (Oct 23, 2014)

36225 since catheter was actually placed *selectively* in the subclavian

435.2
433.10
433.30


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## sandya (Oct 24, 2014)

Wow, I never would have guessed 36225, let alone that being the only code.  thank you very much!!


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