# Need official code set for this procedure!



## 634sg4fs65g4fg (Sep 1, 2010)

Ok, these are the procedures listed and I am still trying to understand the peripheral coding so if anyone can please help me to set up a code set for these procedures I would really appreciate it! 

*Left common femoral angiography. Right common femoral angiography. Angio Extremity Bilateral Lower. Sheath Shot left femoral. PTA Fem Pop Rt. Stent Placement Peripheral Rt. Intervention on right superficial femoral artery: stent*

If anyone can tell me the exact codes for procedures above it will really help me with this one doctor and his codes. Thank  you so much, Gail Davis, CPC


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## Jim Pawloski (Sep 1, 2010)

thomasgail said:


> Ok, these are the procedures listed and I am still trying to understand the peripheral coding so if anyone can please help me to set up a code set for these procedures I would really appreciate it!
> 
> *Left common femoral angiography. Right common femoral angiography. Angio Extremity Bilateral Lower. Sheath Shot left femoral. PTA Fem Pop Rt. Stent Placement Peripheral Rt. Intervention on right superficial femoral artery: stent*
> 
> If anyone can tell me the exact codes for procedures above it will really help me with this one doctor and his codes. Thank  you so much, Gail Davis, CPC



Hi Gail,
First of all, I need to know where access was done.  Were both femoral arteries accessed, or just one, and in what direction (antigrade or retrograde).  Second, since you list both right and left femoral angiography (75710), then bilateral extremity angio (75716), the 75716 takes care of 75710.  Now for the interventions.  Was the doctors intention to stent the right SFA?   If it was, you can not bill for angioplasty, unless the states that there was a dissection, or greater than 80 per cent stenosis after the angioplasty (I hate the comment of suboptimal results used without stating what was found or why).
 The sheath shot is part of the vascular closure (G0290), and cannot be billed.  If that was the puncture, then the catheter code would be 36247.
I hope this will help you out somewhat, but more information is needed.

Good luck,
Jim Pawloski, CIRCC, R.T. (R)(CV)


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## 634sg4fs65g4fg (Sep 1, 2010)

Hi Jim, these peripherals are so hard to code! I know once I am used to them and the exact lingo I will be okay. 
My doctor has a specific cheat sheet he uses when doing these procedures, he circled 36245-50, 75716-26, 37205, and 75960-26
Here is the copied procedures: 
Procedure: The risks and alternatives of the procedures and conscious sedation were explained to the patient
and informed consent was obtained. The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile fashion. ASA rating of 3. Peripheral
catheterization performed electively.
1. Left femoral artery access. The puncture site was infiltrated with local anesthetic. The vessel was
accessed using the modified Seldinger technique, a wire was threaded into the vessel, and a sheath was
advanced over the wire into the vessel.
2. Left common femoral angiography. A catheter was positioned under fluoroscopic guidance.
3. Right common femoral angiography. A catheter was positioned under fluoroscopic guidance.
4. Angio Extremity Bilateral Lower.
5. Sheath Shot left femoral.
Lesion intervention: A stent was performed on the 80 % lesion in the right superficial femoral artery.
Following intervention there was a 0 % residual stenosis. This was an ACC/AHA "non-high risk" lesion for
intervention. There was no perforation. There was no dissection.
1. Balloon angioplasty was performed, using a Opta Pro 5mm X 40mm X 110cm balloon, with 1 inflations
and a maximum inflation pressure of 4 atm.
2. A Smart Control Stent 6mm X 40mm X 120cm bare-metal stent was placed across the lesion and
deployed.
3. Balloon angioplasty was performed, using a Opta Pro 5mm X 40mm X 110cm balloon, with 2 inflations
and a maximum inflation pressure of 10 atm.
Interventions:
1. PTA Fem Pop Rt.
2. Stent Placement Peripheral Rt.
Hope that helps, thanks!


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## 634sg4fs65g4fg (Sep 1, 2010)

Jim, there was 80% stenosis, report states: 1st lesion interventions: Stent was performed on the 80% lesion in the right superficial femoral artery. Following intervention there was a 0% residual stenosis. 
Hope that helps!


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## Jim Pawloski (Sep 1, 2010)

thomasgail said:


> Hi Jim, these peripherals are so hard to code! I know once I am used to them and the exact lingo I will be okay.
> My doctor has a specific cheat sheet he uses when doing these procedures, he circled 36245-50, 75716-26, 37205, and 75960-26
> Here is the copied procedures:
> Procedure: The risks and alternatives of the procedures and conscious sedation were explained to the patient
> ...



Hi Gail,
In reading this report, I have to code this differently.
1. Access left femoral artery, where a sheath was placed.  There is no documentation of any findings on the left side, so you have a unilateral extremity arteriogram (75710).  A catheter position under fluoroscopy does not have an S&I code.
2.Since there is a finding of stenosis in the right SFA, 75710 - S&I Extremity Arteriogram can be billed.
3. After the first angioplasty, there is no mention of dissection or "rebound" stenosis.  I feel that this PTA was a predilation for stent placement which cannot be coded.
Stent Placement of SFA can be coded. Use 37205 and 75960.
4. Second PTA is to completely open the stent, no code.
5. Lt sheath shot is for closure device.  No angio code for this, but G0269 can be coded for the closure device.

So I would bill this as 36247-RT, 75710-RT-59, 37205, 75960-59, G0269.

I hope this helps you.
Have a great Day
Jim Pawloski, CIRCC


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## 634sg4fs65g4fg (Sep 2, 2010)

Thank you!


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## 634sg4fs65g4fg (Sep 2, 2010)

Actually I am confused, the report states Left common femoral angiography, right common femoral angiography, so why would it be unilateral? If he is accessing both the left and right femoral artery wouldn't it be bilateral? Thanks!


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## 634sg4fs65g4fg (Sep 2, 2010)

Wait, after reading again I see he mentions both Lt and Rt angios but only reports access through Left Femoral artery, correct?


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## Jim Pawloski (Sep 2, 2010)

thomasgail said:


> Wait, after reading again I see he mentions both Lt and Rt angios but only reports access through Left Femoral artery, correct?



He does not say if he found anything on the left side.  So I would not bill anything for the left side.  Just that since he went in the left side, I know that I am using selective code for the rt side of the body, starting with 36245 for the right common iliac artery, 36246 for the external iliac and common femoral artery, and 36247 for the SFA and deep femoral artery.

HTH,
Jim


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