# Cpt code for arch angiogram



## OPENSHAW

HELP PLEASE!!!

OUR CARDIOLOGIST DID THE FOLLOWING PROCEDURES:

1.)  ARCH ANGIOGRAM
2.)  RIGHT AND LEFT SELECTIVE CARTOID ANGIOGRAMS WITH SUBTRACTION


THE PATIENT HAS THE FOLLOWING DIAGNOSIS:
1.)  AMAUROSIS FUGAX
2.)  CARTOID ARTERY DISEASE
3.)  Postprocedural percutaneous transluminal coronary angioplasty status
4.)  Carotid artery occlusion and stenosis, without mention of cerebral infarction

IMPRESSIONS

1.)  COMPLEX PLAQUE WITH ULCERATION IN THE RIGHT INTERNAL CARTOID ARTERY WITH 70% STENOSIS
2.)  PROBABLE COMPLEX PLAQUE FORMATION IN THE AORTIC ARCH
3.)  SEVERE DIFFUSE ATHEROSCLEROTIC DISEASE
4.)  GOOD ANGIOGRAPHIC RESULT FROM THE LEFT CARTOID ENDARTERECTOMY THAT WAS PREVIOUSLY PERFORMED

WOULD THIS BE CODED AS                36215
                                                    75680-26
                                                    75710-26


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## jewlz0879

Without the report I can't be 100% certain. I do know the code for arch aortogram is 75650-26. If not a bovine your cath placement codes could be: RCCA - 36216, LCCA - 36215 and 75680-26. 

HTH


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## OPENSHAW

OP REPORT READS:

After permedication with intravenous sedation, the patient was brought to the catheterization laboratory and the right groin prepared and draped.  After 20 ml of 2% lidocaine was infiltrated into the right pectoral area, an 18 thin-walled needle was advanced into the femoral artery in order to allow passage of a short J-wire to an iliac artery.  This was followed by insertion of a 5-French valved sheath.  Through this sheath, a J-wire was used to advance an angled pigtail which was positioned in the ascending aorta; 45 ml of contrast was then injected and a subtraction angiogram was obtained in the LAO projection to examine the arch and takeoff of the great vessels.  We then replaced the pigtail catheter with a JR4 catheter which was advanced into the innominate artery, and with the use of a Stock wire, we advanced the catheter into the right common cartoid artery.  Several subtraction views were taken of the right cartoid artery including the bifurcation.  We then removed the catheter and placed it in the left common cartoid artery where several injections were filmed in a similar fashion.  The catheter was then withdrawn and the wound was closed with a closure device after an angiogram was m,ade through the sheath, which showed that it was suitable for such a closure.  The patient was then sent to the recovery area.

Angiography:
The aortic arch gave off 3 vessels in the usual fashion.  There was diffuse luminal irregularity but no significant stenosis noted in the proximal great vessels.  An indentation was noted in the inferior portion of the arch opposite the great vessels which may have been a complex plaque and will need to be evaluated at a later time.  The right cartoid artery was viewed in several projections.  As stated before, there was some diffuse irregularity of the common cartoid artery.  At the takeoff of the external cartoid artery, there was an 80% proximal obstruction.  The internal cartoidhad a 70% stenosis with an ulcerated plaque and 2 small ulcers noted.  The left cartoid artery showed some diffuse luminal irregularity proximally, but the area encompassing the bifurcation which had been operated previously was free of luminal disease.

Impressions:
1.  Complex plaque with ulceration in the right internal cartoid artery with 70% stenosis
2.  Probable complex plaque formation in the aortic arch
3.  Severe diffuse atherosclerotic disease
4.  Good angiographic result from the left cartoid endarterectomy that was previously performed


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## OPENSHAW

Thank you, I posted the op report so you can see everything.  I really appreciate your help!!!!!


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## dpeoples

OPENSHAW said:


> OP REPORT READS:
> 
> After permedication with intravenous sedation, the patient was brought to the catheterization laboratory and the right groin prepared and draped.  After 20 ml of 2% lidocaine was infiltrated into the right pectoral area, an 18 thin-walled needle was advanced into the femoral artery in order to allow passage of a short J-wire to an iliac artery.  This was followed by insertion of a 5-French valved sheath.  Through this sheath, a J-wire was used to advance an angled pigtail which was positioned in the ascending aorta; 45 ml of contrast was then injected and a subtraction angiogram was obtained in the LAO projection to examine the arch and takeoff of the great vessels.  We then replaced the pigtail catheter with a JR4 catheter which was advanced into the innominate artery, and with the use of a Stock wire, we advanced the catheter into the right common cartoid artery.  Several subtraction views were taken of the right cartoid artery including the bifurcation.  We then removed the catheter and placed it in the left common cartoid artery where several injections were filmed in a similar fashion.  The catheter was then withdrawn and the wound was closed with a closure device after an angiogram was m,ade through the sheath, which showed that it was suitable for such a closure.  The patient was then sent to the recovery area.
> 
> Angiography:
> The aortic arch gave off 3 vessels in the usual fashion.  There was diffuse luminal irregularity but no significant stenosis noted in the proximal great vessels.  An indentation was noted in the inferior portion of the arch opposite the great vessels which may have been a complex plaque and will need to be evaluated at a later time.  The right cartoid artery was viewed in several projections.  As stated before, there was some diffuse irregularity of the common cartoid artery.  At the takeoff of the external cartoid artery, there was an 80% proximal obstruction.  The internal cartoidhad a 70% stenosis with an ulcerated plaque and 2 small ulcers noted.  The left cartoid artery showed some diffuse luminal irregularity proximally, but the area encompassing the bifurcation which had been operated previously was free of luminal disease.
> 
> Impressions:
> 1.  Complex plaque with ulceration in the right internal cartoid artery with 70% stenosis
> 2.  Probable complex plaque formation in the aortic arch
> 3.  Severe diffuse atherosclerotic disease
> 4.  Good angiographic result from the left cartoid endarterectomy that was previously performed




Based on this report I would code:
36216 (RCCA)
36215-59 (LCCA
75680 (bilateral cervical carotid angiography)
75650 (aortic arch angiography) 

HTH


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## OPENSHAW

Thank you so much, i truly appreciate your help!  Are there any recommendations for training in cardiology.  I just started doing cardiology billing not that long ago.  Thank you!!!!!!!


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## OPENSHAW

Danny,
    Can you help me with this op report.  Thank you!
Pta and stent thoracic aorta 

--------------------------------------------------------------------------------

HELP!!!!

I NEED HELP CODING A PTA AND STENT OF THORACIC AORTA. WE ALSO DID A THORACIC AORTOGRAM.

INDICATIONS FOR THE PROCEDURE: STENOTIC AND ANASTOMOTIC LESION OF THE COARCTATION OF THE AORTA THAT WAS SURGICALLY REPAIRED OVER 30 YEARS AGO.

POSTOPERATIVE DIAGNOSIS

FINDINGS: A 125 mm gradient from the ascending aorta to the femoral artery. Discrete lesion, narrow band-like at the distal anastomosis of Dacron graft that was placed in the descending aorta distal to the left subclavian. The lesion was located in the mid thoracic aorta. Again, a gradient of 135 mm was measured.

Description of the Procedure: Under local anesthetic utilizing 2%, the right femoral artery was cannulated and a 7-French sheath was introduced. A 6-French pigtail through a guidewire was able to cross the lesion and was positioned above the stenosis. Thoracic aortogram was performed injecting 50 ml of dye at rate of 25 per second to the PSI of 600 and a rise of 1 second. This was performed in a shallow left anterior oblique that moved the sternal wires out of the field and allowed better visualization of the stenosis. After thoracic aortogram, the lesion was identified and the wire eas left in place. The pigtail was exchanged for a 8 x 2 balloon Boston brand that was cineangiography, the balloon was inflated to 2 atmospheres in order to obtain enough lumen to allow position of the stent. The inflation was maintained for 40 seconds and was then removed. The patient prior to the procedure received 7500 units of heparin.

Once the balloon dialated the lesion, a 10 x 4 stent was advanced and positioned at the site of stenosis. This was correlated with angiography. The stent was then deployed properly, dilated to 10 atmospheres. That gave a good impression that covered the entire aorta. This was maintained inflated for approximately 1 minute. Thereafter, the balloon was deflated and it was noted immediately that the gradient was completely abolished with equalization of pressures between the thoracic aorta and the femoral artery. The patient complained of moderate to severe pain during the deployment of the stent. This, however, was relieved with intravenousfentanyl. The pigtail was then re-advanced and positioned above the lesion. Then, a repeat thoracic aortogram was performed again injecting 50 ml of dye at a rate of 25 per second with a PSI of 600. An excellent angiographic result was noted. The stent was properly deployed and there was no extravasation or dissection at the site of teh stent. Again, there was no gradient being completely abolished after the deployment of the stent. The patient tolerated the procedure well. His pain was ablated with the fentanyl, and the patient was sent to recovery room to have the sheaths removed once the ACT returned to a level below 130. He tolerated the procedure very well. There were no complications.

Thank you!


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