# Angiography



## nancy.anselmo@ccrheart.com (Apr 5, 2012)

Help please in coding this procedure

Procedure: Selective engagement and angiography of the second order thoracic vessels of the left internal mammary artery as well as the right internal mammary artery.

Indications: AP and chest wall injury, Preop coronary artery bypass grafting.

HPI: 73 year-old with newly appreciated cardiomyopathyand severe multivessel coronary disease. History of chest wall injury when he was 6. Likewise, he had vein stripping of lower extremities that had been done electively. Pt was brought for diagnostic angiography of his internal mammary arteries to determine whether or not they are patent and represent potential bypass conduits.

Procedure: Right groin was prepped in the usual sterial fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a French sheath was placed. An IMA catheter was used for selective angiography. After access to the arterial system, the wire was then advanced and placed to the distal subclavian. There was significant subclavian tortuosity; however, the wire easily traversed. A 5-French catheter was then used to selectively engage the internal mammary artery off the subclavian artery. This was used to perform selective angiography in the AP position, which demonstrated the vessel was patent without significant intervening disease and away from the sternum. It's course carried down distally. Attention was then drawn to the right internal mammary artery. Again, significant subclavian tortuosity was encountered. A Terumo Glidewire was then used to navigate the vessel and place the catheter to allow for selective engagement of the right internal mammary artery, which is off the subclavian artery. This too received selective injection that demonstrated patent vasculature without intervening stenosis
Coding: 
36140               414.00      413.9     428.0   V72.81
36217-26          414.00       413.9     428.0   V72.81
36218-26           414.00       413.9     428.0   V72.81
75756-59           414.00       413.9     428.0   V72.81
75774-59           414.00       413.9     428.0   V72.81
  Thanks Nancy


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## Jim Pawloski (Apr 5, 2012)

n.anselmo@yahoo.com said:


> Help please in coding this procedure
> 
> Procedure: Selective engagement and angiography of the second order thoracic vessels of the left internal mammary artery as well as the right internal mammary artery.
> 
> ...



Hi Nancy,
You are overbilled.  You lose 36140 when the catheter goes from non-selective to selective.  36217 is good for the right but should be coded as 36217-RT-26, and the left should be 36217-lt-59-26.  36218 and 75774 are used in the same vascular family, which you are not in.  Bill and additional 75756 for the second LIMA injection.
HTH,
Jim Pawloski, CIRCC


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## nancy.anselmo@ccrheart.com (Apr 6, 2012)

The insurace I am billing does not allow the RT or any modifier like that so I always drop to paper and submit w/the report. Thanks for your help I appreciate it.


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## nancy.anselmo@ccrheart.com (Apr 6, 2012)

Are you saying to bill 75756 twice?


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## Jim Pawloski (Apr 7, 2012)

n.anselmo@yahoo.com said:


> Are you saying to bill 75756 twice?



Check with the physician, but I am assuming the first comment of the internal mammary artery was for the left, and then he talks about the right internal mammary artery.  So I would bill for 75756 for each internal mammary artery
HTH,
Jim


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## nancy.anselmo@ccrheart.com (Apr 9, 2012)

Thanks for your help!


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