# Cath



## nancy.anselmo@ccrheart.com (Feb 8, 2012)

We billed 
37205
35471-59
36245-50-59
75960-26-59
36140-59
The insurance paid everything, but for the 36245-50 they only paid one so I noticed that the codes for 2012 changed and I should bill 36352. My question is do I add modifier 50 to it or do I just bill this once? Thanks Nancy


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## Jim Pawloski (Feb 8, 2012)

n.anselmo@yahoo.com said:


> We billed
> 37205
> 35471-59
> 36245-50-59
> ...



First, you need to show the report because it is hard to figure out what was done.  But the first thing I see is 36245 and 36140. Since 35471 is a renal or visceral angioplasty, 1) 36140 is bundled into the selective 36245.  2) Angioplasty is bundled into the stent placement.  So with the very limited information, I am going to assume this is a renal stent placement.  I would bill this as 36251 for the renal angio, 37205-26-59, 75960-26-59.  Please submit the report so this can be coded properly.
HTH,
Jim Pawloski, CIRCC


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## nancy.anselmo@ccrheart.com (Feb 10, 2012)

*Report*

HIP: patient is 75 w/resistant hypertension and chronic renal disease who developed acut hyperkalemia and renal failure w/the initiation of an ACE inhibitor. Pt had ultrasound vascular studies of his renal arteries that demonstrated concern for bilateral artey stenosis.Despite max medical therapy on greater than 3 antihypertensives including a diuretic, he is referred for diagnostic renal angio.
PROC: R comon femoral artery was assessed using modified Seldinger technique of which a 5 French sheath was placed w/o complication. A nonselective aortography was performed of the abdominal aorta that showed intermediate stenosis of the L renal artery as well as moderate stenosis of the R renal artery. The mesenteric arteries as well as the celiac axis were imaged and there was no significant aortoiliac disease. There was no evidence of a dissection or aneurysm. Selective angioof bilateral artries was then performed w/IMA catheter. This revealed an 80% ostial stenosis of the L renal artery. There was good renal blush and all vascular territories were engaged and visualized w/single injection. The R renal artery was also selectively engaged which showed about 30% proximal disease, however no significant obstruction. Of note, on catheter engagment of the L radial artery there was significant catheter dampening.


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## Jim Pawloski (Feb 13, 2012)

n.anselmo@yahoo.com said:


> HIP: patient is 75 w/resistant hypertension and chronic renal disease who developed acut hyperkalemia and renal failure w/the initiation of an ACE inhibitor. Pt had ultrasound vascular studies of his renal arteries that demonstrated concern for bilateral artey stenosis.Despite max medical therapy on greater than 3 antihypertensives including a diuretic, he is referred for diagnostic renal angio.
> PROC: R comon femoral artery was assessed using modified Seldinger technique of which a 5 French sheath was placed w/o complication. A nonselective aortography was performed of the abdominal aorta that showed intermediate stenosis of the L renal artery as well as moderate stenosis of the R renal artery. The mesenteric arteries as well as the celiac axis were imaged and there was no significant aortoiliac disease. There was no evidence of a dissection or aneurysm. Selective angioof bilateral artries was then performed w/IMA catheter. This revealed an 80% ostial stenosis of the L renal artery. There was good renal blush and all vascular territories were engaged and visualized w/single injection. The R renal artery was also selectively engaged which showed about 30% proximal disease, however no significant obstruction. Of note, on catheter engagment of the L radial artery there was significant catheter dampening.




I hate to say it, but all you have is 36252.  That is the new bilateral 1st order selective renal arteriogram which includes the selective catheter placement and all imaging (including renal arteriogram).  Then you add your stent placement codes.
HTH,
Jim Pawloski, CIRCC


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## nancy.anselmo@ccrheart.com (Feb 13, 2012)

Thank you for your help!


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