# Am I coding this correctly? - Abdominal Aortogram



## AshleyMartin (Jul 29, 2011)

This one really has me confused. This is what I have, please let me know if I am coding this correctly:

36216-RT
36215-LT-59
75671-26
75680-26-59
75605-26-59
36245-LT
75625-26
75716-26-59

Here is the report:

Procedures: Aortic Arch, Selective Carotid/Cerebral Angio, Abdominal Aortogram w/bilat runoff

Access was obtained via the right femoral artery via modified Seldinger technique after 1% lidocaine was used to anesthetize the area. This was done using a Bentson wire. We were able to place a 6-French sheath in and flush without any complications. We introduced initially a pigtail catheter. Aortic arch was performed. We then performed abdominal aortogram. We then switched to a Berenstein catheter. We were able to selectively engage both carotid arteries using an angled Glidewire. Angiography was performed using biplane as well and the cerebral images taken. We then used an Omni flush catheter to cross over the aortoiliac bifurcation. Selective angiographic shots of the left lower extremity were taken. Took selective right lower extremity pictures through the sheath. The sheath was then pulled and hemostasis was achieved using manual pressure.

Findings:
1. Right subclavian artery is subtotally occluded.
2. Right common carotid artery is free of disease. The right internal carotid artery has a 90% lesion. It fills the MCA. The ACA appears to be occluded.
3. Left common carotid appears free of disease. Left ICA has a 50% lesion at the takeoff, fills the MCA and ACA on the left.
4. Bilateral renal arteries are not visualized well enough to comment.
5. Distal abdominal aorta tapers at the bifurcation. There is no evidence of aneurysm or dissection. 
6. Bilateral iliacs have diffuse disease. There is a focal 80%-90% lesion in the left common iliac artery. There is diffuse disease through the right common and external with a focal 80% lesion right at the junction of the iliacs between the external and common. Both internal iliacs are occluded.
7. Right common femoral artery is essentially occluded. The SFA has diffuse disease, it is kind of a small vessel in caliber, however patent through the popliteal to the infrapopliteal vessels. There is 1 and 1.5 runoff to the foot, mostly consisting of the peroneal.
8. Left SFA has some proximal significant disease. Again it is a small vessel with diffuse disease throughtout and extending into the popliteal and down to the trifurcation. The is 1 and 1.5 runoff to the foot, mainly again consisting of the peroneal. 

Any feedback would be greatly appreciated! Thanks!


----------



## kbazarte@yahoo.com (Jul 29, 2011)

All of your codes are correct except 75605 (thoracic aortogram).  You should use 75650.   Below are coding instructions from Zhealth Publishing:

2. Cervicocerebral arch angiography is often performed in conjunction with imaging codes 75680 (cervical carotid bilateral), 75671 (cerebral carotid bilateral), and 75685 (vertebral), and occasionally with codes 75716 (extremity bilateral) and 75662 (external carotid bilateral). This procedure additionally serves as a guide for safe catheterization of vessels supplying the arms, neck, and face and may show evidence of eccentric calcified plaque, proximal stenoses, aneurysm, and dissection. 

3. Cervicocerebral arch angiography is different from the cardiac "aortic root" evaluation (coded 93567). Aortic root injection and imaging is performed during cardiac catheterization for evaluation of the ascending thoracic aorta and "root", for aortic valvular disease, or to evaluate the origins of the native coronary arteries or saphenous vein bypass graft origins. 

4. If more selective catheterization is performed from the same access site [e.g., right or left carotid from a femoral access site (36216, 36215-59)], the non-selective code 36200 is deleted, as it is considered bundled with the selective code. A second arterial access is coded separately and may require modifiers. 

5. Although both the cervicocerebral arch and the descending thoracic aorta are in the thoracic cavity, physican documentation and verbiage may cause confusion. The physician may call a cervicocerebral arch exam a "thoracic" aortogram (75605) when evaluation of the arch and the origins of the great vessels was actually performed and documented. If this is the case, discuss the terminology and documentation with your physician and use code 75650. 

6. If, during a cardiac catheterization, the physician injects the aortic root to evaluate for saphenous vein grafts and aortic vascular disease, but also mentions the arch vessels (without medical necessity), do not code 75650, as the findings are incidental. There must be medical necessity to perform and charge for additional diagnostic angiography. Use code 93567 in this case. 

7. Code 75650 is used to describe imaging related to the evaluation of the origins and proximal portions of the blood supply to the head and neck (common carotid, brachiocephalic, subclavian, and vertebral arteries) and the ascending, transverse, and proximal descending portions of the thoracic aorta (the cervicocerebral cerebral arch).


----------



## dpeoples (Jul 29, 2011)

I agree with kbazarte, all codes are correct except 75605 should be 75650.

HTH


----------



## AshleyMartin (Aug 1, 2011)

Thank you both so much for your input and documentation to support it. I really appreciate it!


----------

