# Diagnostic Angiograms



## sbarbour3 (Apr 27, 2015)

My Dr. just started doing these and I have no earthly idea how to code. I don't know vascular families or anything. Here is the note:

75630,75716, 75774, 36140, 36245, 36246, 36247: Aorta, bilateral pelvic and lower extremity diagnostic angiogram: The right common femoral ARTERY was accessed using 19G needle and micropuncture kit. Access was estabilished using 6 F 11 cm sheath placed in the ARTERY. Using a flush catheter and Benson wire, access was gained to the abdominal aorta. A pelvic angiogram done from here showed normal flow bilateral common iliacs, internal iliacs and external iliac arteries. Using a ZIP glide wire and 5F angled glide catheter, the left common, external and finally the the left common femoral artery was accessed. Runoff angiograms done from here showed normal flow in the left superficial femoral and popliteal arteries. The wire was reintroduced and catheter was advanced into the left proximal popliteal artery. Angiogram done from here showed a patent tibioperoneal trunk with good three vessel flow delineating the left anterior tibial, posterior tibial and peroneal arteries. Runoff angiogram of the foot showed flow in the left lateral malleolar and dorsalis pedis arteries. The wire and catheter were removed. Angiograms done through the sheath showed normal flow in the right superficial femoral and popliteal arteries. There was a patent tibioperoneal trunk with good three vessel flow delineating the right anterior tibial, posterior tibial and peroneal arteries. Runoff angiogram of the foot showed flow in the right medial malleolar and dorsalis pedis arteries. The sheath was removed after right common femoral angiogram showed an inadequate puncture with a high bifurcation. The sheat seemed placed in the right proximal profunda femoris artery. Manual compression was held at the arteriotomy site for 15 minutes for hemostasis. Patient tolerated the procedure well and there were no complications. Blood loss: 15 cc. Fluoroscopy time: 10 minutes 08 seconds. Medications: Fentanyl 25 mcg, Versed 1mg. Omnipaque: 100mls.

He chose the codes but I have no idea if they are right. I have 36245, 36246, 36247, 75630 and 75716.

Can anyone help me?


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## madcomic2000 (Apr 27, 2015)

You are close to correct codes..... This is how I break down the op notes.

1.  catheter in Right com fem - runoff is done 

2.  catheter to aorto and runoff is done; pelvic imaging

3.  catheter to Left comm fem - runoff is done

4.  Catheter to Left Popliteal - runoff is done

Steps 1 and 3, you get to bill 75716 for bilateral imaging (angios) of the lower extremities.  You also get to bill 36246 as you went to the 2nd family in the lower extremities for the basic study.

Step 2 - you can usually bill 75625 for aorta and 75736 for pelvic imaging/runoffs.  Dictation sucks on this one as doctor doesn't state anything about imaging in aorta nor does he state that he moved the catheter between imaging of aorta and pelvis.  

Step 4 - you can bill 75774 for the extra imaging of the popliteal as that was additional imaging of the left leg.  If doctor wouldn't have stopped in the common fem and continued to the tibial peroneal before the initial imaging was done, then you could bill 36247 for catheter placement.  However in this case, you don't go to any 3rd branch vessels.

My codes are 36246, 75625, 75736, 75716, and 75774


75630,75716, 75774, 36140, 36245, 36246, 36247beginning codes)
36245, 36246, 36247, 75630 and 75716. (your codes)

CPT 75630 is not correct as the aortogram with bilateral runoff has to go thru femoral arteries, this test goes thru iliacs only.

CPT 36140 is the puncture of the Right Common femoral artery - you CANNOT bill for this if you move catheter beyond the aorta as it's bundled.

CPT 36245 is also not billable in this case as you have to go thru a 1st branch to get to the 2nd branch  -this will bundle per CCI.

CPT 36247 is not correct as the 3rd branch family is the the anterior tibial or peroneal family - you didn't go into any of these.

You have to have reference books with detailed vein/artery info so you know which ones are in which family.  You CANNOT code interventional radiology without one.  Look into MedLearn or Dr. Z Health as they both have exceptional references updated each year.  There are many rules on bundling and unbundling on these procedures and you have to know when you can and cannot bill certain CPT codes.  Your doctor does not seem to have a good grasp on the correct coding of this either.  

In our group, I have 3 vascular surgeons - 1 knows his stuff, another tries and gives me codes similar to your example and the other doesn't even attempt to code it.  Leaves it up to me.


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## sbarbour3 (Apr 27, 2015)

*Thanks*

Thank you so very much. I have never done anything like this before and the Dr. really stinks at charting. This is an example of his notes on a good day! I have a Complete Guide for Interventional Radiology but that is so over my head. It is the vascular families that I truly don't understand. Thanks again for taking time out of your busy day to help me.


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