# Help w/coding this IR procedure???



## dimplez (Mar 29, 2011)

Can someone please assist with this procedure?  I have never done these before and am assisting someone who is debating with the dr on coding the separate runoff while he states the code for the total aortogram and extremeities.  She is saying since he repositioned the catheter he should be reporting separately....any advice??  Here is the procedure note.

_The right groin was locally anesthetized with 1% lidocaine without epinephrine. The right common femoral artery was accessed in a retrograde manner using a 5-French micropuncture set. The patient received 2000 units of intravenous heparin. Over a 0.035 inch guidewire, a 5-French sheath was placed and a 5-French Omni Flush catheter was positioned in the proximal abdominal aorta. An AP aortogram was performed using power injection angiography. Next, the pigtail catheter was positioned above the aortic bifurcation, and an additional view of the distal aorta and bilateral common iliac arteries and proximal femoral vessels was performed using power injection angiography. A 0.035 inch Glidewire and a 5-French Omni Flush catheter was used to selectively catheterize, the left iliac system and under fluoroscopic guidance, the 5 French catheter was advanced to the level of the left common femoral artery. Left lower extremity runoff was then performed in a sequential fashion down to the level of the foot with multiple oblique views at the level of the knee in order to visualize the vessel, given the presence of a prosthetic knee joint. The pigtail catheter was positioned in the right common iliac artery and right lower extremity angiography was performed in a sequential fashion with oblique views performed at the level of the knee. Following this, the catheters, guidewires, and sheaths were removed and pressure was held over the right groin with satisfactory achievement of hemostasis. The patient tolerated the procedure well and was transported to the recovery area for further care and monitoring._

Any assistance and I will be greatly appreciative! Thank you, Marisa


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## Jim Pawloski (Mar 29, 2011)

dimplez said:


> Can someone please assist with this procedure?  I have never done these before and am assisting someone who is debating with the dr on coding the separate runoff while he states the code for the total aortogram and extremeities.  She is saying since he repositioned the catheter he should be reporting separately....any advice??  Here is the procedure note.
> 
> _The right groin was locally anesthetized with 1% lidocaine without epinephrine. The right common femoral artery was accessed in a retrograde manner using a 5-French micropuncture set. The patient received 2000 units of intravenous heparin. Over a 0.035 inch guidewire, a 5-French sheath was placed and a 5-French Omni Flush catheter was positioned in the proximal abdominal aorta. An AP aortogram was performed using power injection angiography. Next, the pigtail catheter was positioned above the aortic bifurcation, and an additional view of the distal aorta and bilateral common iliac arteries and proximal femoral vessels was performed using power injection angiography. A 0.035 inch Glidewire and a 5-French Omni Flush catheter was used to selectively catheterize, the left iliac system and under fluoroscopic guidance, the 5 French catheter was advanced to the level of the left common femoral artery. Left lower extremity runoff was then performed in a sequential fashion down to the level of the foot with multiple oblique views at the level of the knee in order to visualize the vessel, given the presence of a prosthetic knee joint. The pigtail catheter was positioned in the right common iliac artery and right lower extremity angiography was performed in a sequential fashion with oblique views performed at the level of the knee. Following this, the catheters, guidewires, and sheaths were removed and pressure was held over the right groin with satisfactory achievement of hemostasis. The patient tolerated the procedure well and was transported to the recovery area for further care and monitoring._
> 
> Any assistance and I will be greatly appreciative! Thank you, Marisa



Hi Marisa,
Here is what I found in reading this report.  There is two catheter positions used in the procedure.  So I would bill 75625- Abdominal Aorta, and 75716 for bilateral extremity arteriogram.  If the catheter was not moved from the origional position, then you bill 75630 for abdominal aortogram w/ run-offs.  As for catheter position, the catheter went to the lt common femoral artery, so I would bill it 36246 - seecond order selective below diaphram.
Hope that helps,
Jim Pawloski, CIRCC


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## Rajebpt (Mar 30, 2011)

My codes are
36246-contralateral sfa catheterisation
75625-if visceral arteries(renal) documented
75716-bilateral extremity angio
75774-additional evaluation from sfa level


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## kbazarte@yahoo.com (Mar 30, 2011)

Jim is correct the codes are:

75625


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## kbazarte@yahoo.com (Mar 30, 2011)

Jim is correct the codes are:

75625
75716
36246

I did not see in the dictation any documentation to supprt 75774 eadch add'l after basic selective


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## Jim Pawloski (Mar 30, 2011)

kbazarte@yahoo.com said:


> Jim is correct the codes are:
> 
> 75625
> 75716
> ...



That's what I saw.  I figured the doctor placed the catheter in the Lt common femoral and injected to look at the left leg, then pulled back into the right common iliac (or he/she could have just injected through the sheath) to look at the right leg.  No support for angio after the basic (75774).  Also 75726 is the abdominal aorta, not visceral angio.  To use a visceral angio charge, it must be selective.  I used the two codes because there was catheter movement, although I would rather see the report say that the catheter was placed in the aorta at the level of the renal arteries or suprarenal aorta.  
Have a great day everyone!
Jim Pawloski, MSA, CIRCC


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## Scruggs1 (Apr 1, 2011)

*Interesting Case:  What about this?*

I think I can see why the other person got the 75774.  The physician was in the aorta  (high and low) did injection crossed the bifurcation over into the left iliac, goes to the left common femoral artery and shoots down to the leg. Maybe I am misinterpreting this from the DR. Z reference:

_Aortogram and complete run-off from high and low catheter positions (via femoral approach) with selective catheter placement and additional imaging from the contralateral common femoral artery with pull back into the ipsilateral iliac and additional images of the ipsilateral leg (36246, 75625, 75716, 75774_). 




Love this stuff!!


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## bkipferl (Jul 15, 2020)

I have a question about this procedure do I code 36200 only or 36245. Please help

PROCEDURE NOTE:  
After obtaining informed consent the patient was taken to the cath lab where he was prepped and draped in the usual sterile manner.  The right groin was infiltrated with plain xylocaine in the right femoral artery was cannulated and a 5 French inducer sheath was inserted.  A 5 French pigtail catheter was used to perform an abdominal aortogram selectively for the iliacs and terminal aorta only.  The catheter was advanced under fluoroscopic guidance over a guidewire the catheter was was flushed before angiography was performed.


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## such78 (Jul 15, 2020)

36200, I don't see the catheter went beyond the aorta.


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## megg1100 (Jul 17, 2020)

Scruggs1 said:


> *Interesting Case:  What about this?*
> 
> I think I can see why the other person got the 75774.  The physician was in the aorta  (high and low) did injection crossed the bifurcation over into the left iliac, goes to the left common femoral artery and shoots down to the leg. Maybe I am misinterpreting this from the DR. Z reference:
> 
> ...



 75774 is not applicable here because he selected the femoral artery to complete the leg. 75774 is for additional selective imaging AFTER a COMPLETE exam.


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