# Aortogram - confirm my codes



## prabha (Aug 11, 2010)

36215
36215X6-59
75605-26
75650-26
75710-26
75705X6-26

Can anyone please confirm my codes for the below pocedure


Patient is a 60-year-old male with COPD exacerbation, intubated.
      He now presents with massive hemoptysis, a witnessed episode of at
      least 800 cc


The patient's right groin was prepped and draped in usual sterile
      manner and locally anesthetized with 1% lidocaine. The right
      common femoral artery was accessed with a micro-puncture site,
      exchange made for a 6 French vascular sheath. A 5 French Omni
      Flush catheter was advanced into the aortic arch. Digital
      subtraction aortography was performed in 45? left anterior oblique
      projection.

      A Simmons 2 catheter was reformed over the aortic arch and used to
      selectively catheterize the left subclavian artery. Digital
      subtraction angiography was performed with injection into the left
      subclavian artery.

      Due to inability to identify any potential bleeding or abnormal
      vessel, repeat aortography was performed this time with the
      catheter in the descending thoracic aorta. The right-sided
      intercostal bronchial trunk was identified, and selective
      catheterization was performed using a 5 French Cobra catheter.

      Exchange was then made for a Mickelson catheter and selective
      catheterization was performed of multiple intercostal arteries
      with contrast injection.

      Findings:      
      All of the visualized injected vessels are unremarkable. Aortic
      arch and descending thoracic aorta injection reveals no abnormal
      area of hypervascularity in either lung field. The internal
      mammary arteries are identified bilaterally, and are unremarkable
      in appearance.  Injection of the right intercostal bronchial trunk
      is unremarkable as well, the vessel is not hypertrophied and this
      does not appear to be a bleeding source. Numerous other
      intercostal arteries were injected, also unremarkable in
      appearance.

      At the end of the procedure the catheter and sheath were removed
      and hemostasis achieved with manual compression. No embolization
      was performed, due to inability to find any abnormal, possibly
      bleeding vessel.

      Impression:      
      Arch aortagram, descending thoracic aortogram, left subclavian
      artery arteriogram, as well as selective injections into the
      intercostobronchial trunk and multiple intercostal arteries are
      all unremarkable. No area of hypervascularity is identified and no
      embolization was performed.


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## sgochoco (Aug 13, 2010)

*Slg*

I did not check all of your codes, but there are a few things that stand out when reading the note.  I noticed the phrase "All of the visualized injected vessels are unremarkable".  I feel the vessels in particular that are being referred to should be listed.  

I also did not see an interpretation for the Subclavian specifically.  

How did you arrive at 75706 X 6 ?


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## Terry L (Aug 29, 2010)

*Chest vs spine case*

Hi  

I would have coded 75726 instead of 76705.  The patient has hempotysis not an issue with their spine.  75726 would be the correct code in a chest case


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## boogiebowden (Sep 2, 2010)

*cath placements*

I would be leary to code that many cath placements when the physician is not being clear on the number of intercostals he selectively engaged.  That also will play part in how many angios (75726) you bill.  (I agree with everyone's comments on the 75706 should be 75726)


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## fredcpc (Dec 16, 2010)

*Aortogram, new at this*

Could an Aortogram be done with selective catheterization?


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## Jim Pawloski (Dec 17, 2010)

fredcpc said:


> Could an Aortogram be done with selective catheterization?



Depends on what vessels were selected.  The aortic arch can be billed w/ selective carotids/ vertebrals, but not in the abdomen where they are bundled.

Jim Pawloski, CIRCC


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