# kissing technique



## scorrado (Jul 28, 2008)

Our cardiologists have recently begun doing peripheral procedures and I was wondering if anyone knows the best way to code for the "kissing technique".  The physician deployed two balloons simultaneously from both the right and the left groin in each iliac artery to prevent closure of one artery while treatment of the other.  I know that I have heard this mentioned in a seminar, but I have been unable to find how to bill for this in my reference material.

Thanks a bunch!


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## dpumford (Jul 29, 2008)

Hello,

When doing the kissing tech and if both groins are accessed and catheters are placed from both sides you will have two cath placements codes Lt & Rt.  It all depends were the catheters end up. What iliac artery is he in? common, internal or external? Does he cross the aortic bifurcation?  If he does you code to the higher level? You can give credit to two PTCA if not done in the same vessel.

Do you have a Lower extremity  anatomy flow sheet that shows the catheter placements?  
If you don't let me know and I can fax you a copy! This is a must in order to bill peripheral vascular correctly.

Hope this helped!


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## scorrado (Jul 29, 2008)

Thanks very much for the reply.  He was in the common femorals to do a dual stent placement at the aortoiliac bifurcation.  I suppose the best coding for the level would be 36245-59 and 36245-59 to indicate both common iliac arteries were selectively engaged.  Thanks for the offer of the flow sheet for the order of the lower extremity vasculature.  I do indeed have a pretty good one, but I didn't know if there was some more specific way to code for this technique.  

Thanks again!


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## dpumford (Jul 29, 2008)

Hello again and you are welcome!

I would like to give you a tip on coding perpherial vascular, it can be tricky but the best thing to remember is if the doctor DOES NOT cross over the aorta bifurcation, you can not code for the selective placement,36245. He must cross over. If he does not crossover you would need to you code 36200 or 36140. 

So in order to code the 36245 like you stated your doctor would of had to ie: access on the Right side, crossover, then selectively engage the common femoral on the Left. 

Have fun and if any more questions would be happy to assist!


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## BCSTACY (Aug 13, 2008)

could yo please fax me a copy of the flow sheet also at BSTACY@CAK.COM?
thank you very much


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