# Help..



## peeya (Oct 19, 2010)

Can some please help me code this procedure..

I know the the cath codes should be:

93510-26
93543
93555-26
93545
93556-26

But I am confused about how to code "Angiography of the abdominal aorta with runoff"

PROCEDURES
1. Left heart catheterization.
2. Selective left and right coronary angiography.
3. Cineventriculography.
4. Supervision and interpretation of coronary angiography.
5. Right femoral angiography.
6. Angiography of the abdominal aorta with runoff.

MEDICATIONS
1. Lidocaine 2% subcutaneously 8 mL.
2. Versed, a total of 1 mg IV.
3. Fentanyl total of 25 mcg intravenously.

PATIENT IDENTIFICATION DATA:  This is a 51-year-old male patient with leg pain of an exertional nature, as well as, chest pain, and he was electively taken to the cardiac catheterization laboratory after evaluation of a stress test, which was positive for ischemia.

Prior to the procedure, I explained to the patient the benefits and risks of this procedure, which include but are not limited to death, myocardial infarction, stroke, renal failure, contrast allergy, groin pain, groin infection, emergent bypass or vascular surgery, loss of limb, need for aspirin and Plavix over a prolonged amount of time. He fully understands and agrees and wishes to proceed.

DESCRIPTION OF PROCEDURE:  Following informed consent, the patient was brought to the catheterization laboratory, where the right groin was prepped in usual sterile fashion. Xylocaine 1%, 8 mL, was infiltrated into the right groin for local anesthesia. A 6-French sheath was introduced in the right femoral artery using the modified Seldinger technique. A 6-French JL4 and a 6-French JR4 catheter was used for selective left and right coronary angiography respectively. Subsequently, a pigtail catheter was advanced through the left ventricle, where pressure measurements were obtained. Cineventriculography was performed using 21 mL of contrast dye. Following this part of the procedure, the pigtail was placed just above the iliac bifurcation and abdominal angiography was performed with peripheral runoff. Subsequently all catheters were removed, as was the sheath, and manual pressure was applied until very good hemostasis was obtained. There were no complications during the procedure. The total amount of contrast used was 115 mL. Total fluoroscopy time was 3.2 minutes.

HEMODYNAMICS
1. Opening aortic pressure is 142/91/114.
2. Left ventricular pressure at baseline 139/11, with left ventricular end-diastolic pressure of 23 mmHg.
3. Left ventricular pressure post cineventriculography 141/13, with left ventricular end-diastolic pressure of 24 mmHg.
4. There was no gradient during pullback of the pigtail catheter from the left ventricle and the ascending aorta.
5. Final aortic pressure 138/87/111.

DESCRIPTION OF CORONARY ANATOMY
1. The left main artery has no evidence of significant obstructive disease.
2. The left anterior descending artery reveals a 50% long lesion reaching from the proximal to mid section, until the very distal end of the LAD, where this vessel tapers down to a very small, sclerosed vessel.
3. The circumflex artery has no focal obstructive disease and reveals mild arteriosclerotic changes.
4. The right coronary artery reveals no focal obstructive disease, and has mild arteriosclerotic changes.

CINEVENTRICULOGRAPHY:  There is a normal sized left ventricle without regional wall motion abnormalities. Estimated ejection fraction of 65%. There is no significant mitral valve regurgitation.

RIGHT FEMORAL ANGIOGRAPHY:  The sheath entry point is visualized above the bifurcation and there is no significant stenosis.

ANGIOGRAPHY OF THE ABDOMINAL AORTA WITH RUNOFF:  There is a patency without focal obstructive disease of the iliac arteries, the superficial femoral arteries, the profunda femoral arteries, the common femoral arteries and the popliteal arteries on both sides. The trifurcation below the knee is patent on both sides. On the right side there is a dual vessel runoff with patency of the anterior tibial artery and the posterior tibial artery; however, slow flow in the distal sections of these vessels is noted. The plantar arch on the right side is patent, and provided by the posterior tibial artery. On the left side, there is a single vessel runoff with patency of the anterior tibial artery. There is proximal occlusion of the peroneal artery, and there is proximal occlusion of the posterior tibial artery.

CONCLUSION
1. This is a 51-year-old male patient with exertional symptoms, positive stress test and claudication, who was electively taken to the cardiac catheterization laboratory. He was found to have patency of his coronary arteries. However, a 50% lesion is noted over a long distance in the LAD from the proximal to the distal end of the LAD. Due to the small luminal size in the very distal end, and the complex the procedure with equivocal results, it was decided to proceed with medical therapy also, given the fact that this lesion is to a maximum of 50% luminal narrowing.
2. There is preserved left ventricular function.
3. We found occlusion of the left peroneal artery, the left ankle and foot has a single vessel runoff. Medical therapy is advised.


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## theresa.dix@tennova.com (Oct 20, 2010)

I would use 75716-59 with dx 440.20


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## dpeoples (Oct 20, 2010)

theresa.dix@ethc.com said:


> I would use 75716-59 with dx 440.20



I agree with Theresa.
HTH


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## peeya (Oct 20, 2010)

but not the 75630? 

See I am confused because the doctor mentioned he did - "abdominal angiography was performed with peripheral runoff" and the 75630 is also called abdominal with runoff..


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## dpeoples (Oct 20, 2010)

peeya said:


> but not the 75630?
> 
> See I am confused because the doctor mentioned he did - "abdominal angiography was performed with peripheral runoff" and the 75630 is also called abdominal with runoff..




The documentation does not support 75630. Here is the interpretation..

"_ANGIOGRAPHY OF THE ABDOMINAL AORTA WITH RUNOFF: There is a patency without focal obstructive disease of the iliac arteries, the superficial femoral arteries, the profunda femoral arteries, the common femoral arteries and the popliteal arteries on both sides. The trifurcation below the knee is patent on both sides. On the right side there is a dual vessel runoff with patency of the anterior tibial artery and the posterior tibial artery; however, slow flow in the distal sections of these vessels is noted. The plantar arch on the right side is patent, and provided by the posterior tibial artery. On the left side, there is a single vessel runoff with patency of the anterior tibial artery. There is proximal occlusion of the peroneal artery, and there is proximal occlusion of the posterior tibial artery_".

The doc does not give any information related to the aorta. All documenation (interpretation) relates only to the lower extremity arteries. CPT code 75630 _requires_ an interpretation of the _aorta and iliac/femoral arteries_.

HTH


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## peeya (Oct 20, 2010)

How about the 75625 then. The Doctor did say he did an abdominal angiography " Following this part of the procedure, the pigtail was placed just above the iliac bifurcation and abdominal angiography was performed with peripheral runoff"

Should it not be billed as 75625 & 75716? Please help.


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## theresa.dix@tennova.com (Oct 21, 2010)

peeya said:


> How about the 75625 then. The Doctor did say he did an abdominal angiography " Following this part of the procedure, the pigtail was placed just above the iliac bifurcation and abdominal angiography was performed with peripheral runoff"
> 
> Should it not be billed as 75625 & 75716? Please help.



No, it is the 75716-59 ONLY. It is very confusing. There was only ONE injection done.So there should be only ONE injection code. One injection at the bifurcation and it ran off into the extremities.


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