# Carotid Angiogram - innominate artery



## smiller (Jun 20, 2013)

Hi everyone:  I need help with this report - I'm learning the new carotid angiograms and want to see if I'm on the right track, so here's the report:

PROCEDURE:
  1.  Selective injection of the innominate artery.
  2.  Selective injection of the right common carotid artery.
  3.  Selective injection of the left common carotid artery.
  4.  Selective injection of the left subclavian artery.
  5.  Selective injection of the left vertebral artery.
  6.  Vascular closure of the right common femoral artery with a
      Mynx Grip device.

INDICATION:  Cerebrovascular accident, abnormal carotid
ultrasound.

Following arterial puncture of the right common femoral artery,
we placed a vertebral catheter in the various locations mentioned
up above.  Selection injection of the innominate artery
demonstrated normal appearance of this distribution.  A
nonselective injection of the right subclavian artery
demonstrated normal appearance.  Nonselective injection of the
right vertebral artery demonstrated 25% narrowing.  The catheter
was then advanced into the right common carotid artery
demonstrating a normal appearance of this distribution.  The
right internal carotid artery demonstrated a 99% stenosis with
very sluggish flow.  The right external carotid artery was widely
patent.  The right middle and right anterior cerebral arteries
filled via the anterior communicating branch from the left
circulation.  They were normal through their course.  The
catheter was then placed in the left common carotid artery
demonstrating normal appearance of this distribution.  The left
internal carotid artery demonstrated a 25% narrowing.  The left
external carotid artery was widely patent.  The left middle and
left anterior cerebral arteries were widely patent.  As mentioned
previously, the right circulation filled via the anterior
communicating branch from the left anterior cerebral artery.  The
catheter was then advanced into the left subclavian artery
demonstrating normal appearance of this distribution.  The left
vertebral artery was selectively cannulated and demonstrated an
ostial 95% narrowing.  Following the procedure we closed the




                     CARDIAC CATHETERIZATION
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right common femoral artery with a Mynx Grip device.



CONCLUSION:
  1.  Normal appearance of the innominate artery.
  2.  Normal appearance of the right subclavian artery.
  3.  Mild narrowing in the right vertebral artery.
  4.  Normal appearance of the right common carotid artery.
  5.  Critical narrowing of the right internal carotid artery.
  6.  Normal appearance of the right external carotid artery.
  7.  Normal appearance of the right middle and right anterior
      cerebral arteries filling via the left circulation.
  8.  Normal appearance of the left common carotid artery.
  9.  Normal appearance of the left external carotid artery.
  10. Mild narrowing of the left internal carotid artery.
  11. Normal appearance of the left middle and left anterior
      cerebral arteries.
  12. Normal appearance of the left subclavian artery.
  13. Significant narrowing of the left vertebral artery.
  14. Successful vascular closure right common femoral artery
      with a Mynx Grip device.

Here are the codes I come up with:  36226-50
                                                     36223-51-50

Any help is appreciated


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## dpeoples (Jun 21, 2013)

smiller said:


> Hi everyone:  I need help with this report - I'm learning the new carotid angiograms and want to see if I'm on the right track, so here's the report:
> 
> PROCEDURE:
> 1.  Selective injection of the innominate artery.
> ...



It does not appear that the RT Vertebral was selected, I would code:
36226 Lvert
36225 Rvert (from rt subclavian selection/injection)
36223-51,50 RT/LT common carotids


HTH


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## smiller (Jun 24, 2013)

*Carotid Angiogram*

Hi Danny - thank you Can you explain more how you're getting 36225? - I see several non-selective injections on the right side until the right common carotid is selected.  Isn't it still coded highest order per vascular family?


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