# peripheral angiogram and PTA



## lcaskew1 (Feb 5, 2015)

My doctor did an abdominal aortography with iliofemoral runoff, a bilateral lower extremity angiography with distal vessel runoff, and a left anterior tibial balloon PTA at 2 sites. This is how he told me to code it. Please tell me if it is correct.

36247
36140
37228
75630-26 (I think this should be 75625-26)
75716-26

Also, do I need modifier -59 anywhere? Thanks!
Lynette Askew


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## Jim Pawloski (Feb 5, 2015)

lcaskew1 said:


> My doctor did an abdominal aortography with iliofemoral runoff, a bilateral lower extremity angiography with distal vessel runoff, and a left anterior tibial balloon PTA at 2 sites. This is how he told me to code it. Please tell me if it is correct.
> 
> 36247
> 36140
> ...



Need a report to confirm the codes. But just looking at it, 36247 and 36140 are bundled into the intervention, so it needs to be removed.  If the catheter was moved from upper abd. aorta to the lower abd. aorta, and the renals are reported, then you have 75625-26-59, 75716-26-59.  If the renals are not reported, then bill just 75716-26-59.
HTH,
Jim Pawloski, CIRCC


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## lcaskew1 (Feb 6, 2015)

Here is the report.
After informed consent was obtained from the patient and his family, he is brought to the cath lab whre his right femoral region was prepped, draped and infiltrated with Xylocaine. A 5-French sheath was placed in the right femoral artery via the modified Seldinger technique. A 5-French pigtail catheter was position in the lower portion of the abdominal aorta. Abdominal aortography with iliofemoral runoff was was performed in the PA view. This catheter was then used to advance an angled Glidewire into the left superficial femoral artery. The catheter was exchanged over the wire for a 5-French angled glide catheter, which was positioned in the left SFA. Left leg angiography with distal vessel runoff was performed in the PA view. This catheter was brought back and angled views of the femoral bifurcations were made bilaterally. Right leg angiography with distal vessel runoff was then performed in 2 views. This catheter was removed.
Heparin 3000 units was given intravenously. The 5-French pigtail catheter was used to advance the angled Glidewire into the left SFA. The angled glide catheter was then posisioned in the left SFA. A 6-French sheath was then placed over the Amplatz wire into the left SFA.
An excahange length Journey guidewire was used to advance into the anterior tibial artery beyond the 2 areas of stenosis. A 2.5 x 40 mm balloon was used to dilate both stenoses at 7 and 8 atmospheres. The balloon was brought back. Nitroglycerin was given down the artery and final angiography was performed. The balloon and guidewire were removed from the sheath.
Using its introducer and the Amplatz wire, the long sheath was taken back across the aortic bifurcation. It was then removed and hemostasis was achieved using a StarClose closure device.


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## lcaskew1 (Feb 6, 2015)

Also, would reporting 75630 be equal to reporting 75625 with 75716? If not, please help me understand the difference. Thank you!
Lynette


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## Jim Pawloski (Feb 6, 2015)

lcaskew1 said:


> Here is the report.
> After informed consent was obtained from the patient and his family, he is brought to the cath lab whre his right femoral region was prepped, draped and infiltrated with Xylocaine. A 5-French sheath was placed in the right femoral artery via the modified Seldinger technique. A 5-French pigtail catheter was position in the lower portion of the abdominal aorta. Abdominal aortography with iliofemoral runoff was was performed in the PA view. This catheter was then used to advance an angled Glidewire into the left superficial femoral artery. The catheter was exchanged over the wire for a 5-French angled glide catheter, which was positioned in the left SFA. Left leg angiography with distal vessel runoff was performed in the PA view. This catheter was brought back and angled views of the femoral bifurcations were made bilaterally. Right leg angiography with distal vessel runoff was then performed in 2 views. This catheter was removed.
> Heparin 3000 units was given intravenously. The 5-French pigtail catheter was used to advance the angled Glidewire into the left SFA. The angled glide catheter was then posisioned in the left SFA. A 6-French sheath was then placed over the Amplatz wire into the left SFA.
> An excahange length Journey guidewire was used to advance into the anterior tibial artery beyond the 2 areas of stenosis. A 2.5 x 40 mm balloon was used to dilate both stenoses at 7 and 8 atmospheres. The balloon was brought back. Nitroglycerin was given down the artery and final angiography was performed. The balloon and guidewire were removed from the sheath.
> Using its introducer and the Amplatz wire, the long sheath was taken back across the aortic bifurcation. It was then removed and hemostasis was achieved using a StarClose closure device.



After reading the report, I would only code 37228-26 and 75716-26-59.  The catheter was only placed in the distal aorta, and the renals are not described. So no aortogram charge.
Thanks,
Jim


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## Jim Pawloski (Feb 6, 2015)

lcaskew1 said:


> Also, would reporting 75630 be equal to reporting 75625 with 75716? If not, please help me understand the difference. Thank you!
> Lynette



If the catheter is first placed at the level of the renal arteries, and the renals are imaged and reported, then code 75625.  Then the catheter is moved down to the bifurcation and both legs are imaged and reported, the bill 75716.
For 75630, if the aorta and both legs are imaged without the catheter moved from the renal artery position, then bill 75630.  Also bill 75630 if the imaging is for a aortic aneurysm.

HTH,
Jim


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## stephanie7480 (Feb 9, 2015)

*Renals?*

Jim
Where can I find documentation about the need for the renals to be imaged and findings reported to report 75625? Encoder doesn't say anything about renal imaging.
Thanks


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## Jim Pawloski (Feb 9, 2015)

stephanie7480 said:


> Jim
> Where can I find documentation about the need for the renals to be imaged and findings reported to report 75625? Encoder doesn't say anything about renal imaging.
> Thanks



Dr. Z's or MedLearn coding books.  Z states that the entire abdominal aorta has to be described to get 75625 or 75630.
Thanks,
Jim Pawloski, CIRCC


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