# Aortogram w/runoff & selective bilateral iliac distal leg runoff



## armedical (Oct 15, 2013)

Looking for 2nd opinion on coding; 

We coded 36245-LT, 36246-RT, 75716-26, 75625-26

Date of Procedure 09/01/2013

Procedure: Aortogram w/runoff and selective bilateral iliac distal leg runoff. 

Indication: Bilateral claaudication w/ABI of 0.7 on the left. 

Procedures Performed: Aortogram & Selective cannulation of the iliacs from the radial position and runoff to both legs bilaterally.

Procedure Description: The patient was brought to th ecardiac cath lab, prepped and draped in sterile fashion.  1% lidocaine was used to infiltrate the right radial artery.  A 6-French side-arm sheath for modified Seldinger technique was placed in the right radial artery.  I then took a 5-french 100cm pigtail and performed digital subtraction angiography in AP position of the abdomen and iliac.  I then removed the pigtail and placed 135 cm Quick-Cross and used a 260 cm Glidewire to selectively cannulate the right common femoral and placed the catheter at the point and did runoff to the foot of the right leg.  I then manipulated the catheter into the right common femoral and performed angiography of the left system runoff. 

Results: Results of diagnostic angio are as follows:  The patient's aortogram showed mild to moderate disease with a distal aortic aneurysm seen with patent iliacs, internal, external, bilaterally, patent renal arteries bilaterally.  The aneurysm appeared to be between 4.5 and 5 cm in diameter.  The right leg is as follows:  The common femoral is patent.  The SFA is patent with mild diffuse disease and profunda is patent.  The popliteal is patent.  There is a 2-vessel runoff with patent TP trunk.  There is a high-grade ostial anterior tibial stenoses with a patent posterior tibial and peroneal artery.  The left leg shows mild to moderate disease of the SFA and patent profunda, patent popliteal.  The left appeared to have a subtotally occluded anterior tibial, a patent peroneal and an occluded posterior tibial.  Case was concluded at this time with a TR band to the right radial artery. 

Impression :  This patient has an obdominal aortic aneurysm and sevenre peripheral vascular disease in the left with 1-vesswel runoff of the left leg, left foot, infrapopiteal and 2-vessel runoff infrapopliteal of the right.  

Recommentation: The paient will be sent for a CT scan to better size her aortic aneurysm and see if she is a candiate for stent graft.


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## christoff9 (Oct 15, 2013)

Assuming that the last sentence is a typo and should be left, you would code 36246 LT and RT.  Your angio codes are correct.


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## jroxas (Oct 15, 2013)

Yes, I agree, there was a typo, should be Left common femoral artery Codes are 36246-RT, 36246-LT 75625-26, 75716-26 since the approach is upper extremity
Jerry E. Roxas, CPC


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