# Abdominal aortogram-help with this.



## MADDIE (Mar 22, 2012)

Please help with this. Puncture right femoral artery J-wire advanced into abdominal aorta followed by ultra flush catheter and abdominal aortogram performed. The catheter was pulled down to the level of the bifurcation and iliac runoff was obtained. Then catheter was advanced to the left femoral artery and a left femoral arteriogram was performed. The wire was advanced throught the catheter and the catheter pulled out and a right femoral arteriogram was performed.

Findings: patent aorta, renal arteries and iliac arteries on both sides.
              left side: patent profunda, occlude SFA at origin. Popliteal occluded at the knee 
              joint. peroneal only vessel reconstituted beyond multiple collaterals all the way 
              down to the ankle.
              right side: profunda open but occluded after first branch. SFA occluded after
              origin. Popliteal reconstitued above knee, main runoff via peroneal which 
              reconstituteds dorsalis pedis.

Codes: 36246, 75716/26 75625/26 I am stuck on the catheter placement at the bifurcation and then iliac runoff...as there is movement of the catheter from high to a low position but only the iliacs are viewed? Then right and left arteriograms are performed?

Thanks in advance for any help.


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## Jim Pawloski (Mar 22, 2012)

MADDIE said:


> Please help with this. Puncture right femoral artery J-wire advanced into abdominal aorta followed by ultra flush catheter and abdominal aortogram performed. The catheter was pulled down to the level of the bifurcation and iliac runoff was obtained. Then catheter was advanced to the left femoral artery and a left femoral arteriogram was performed. The wire was advanced throught the catheter and the catheter pulled out and a right femoral arteriogram was performed.
> 
> Findings: patent aorta, renal arteries and iliac arteries on both sides.
> left side: patent profunda, occlude SFA at origin. Popliteal occluded at the knee
> ...



Hi Maddie,
I agree with your codes.  If the catheter was pulled down after the abdominal aortogram, and a full bilateral extremity arteriogram was performed, then you would have 36200, 75625 and 75716.  But the catheter went selective.
HTH,
Jim Pawloski, CIRCC


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## dpeoples (Mar 22, 2012)

MADDIE said:


> Please help with this. Puncture right femoral artery J-wire advanced into abdominal aorta followed by ultra flush catheter and abdominal aortogram performed. The catheter was pulled down to the level of the bifurcation and iliac runoff was obtained. Then catheter was advanced to the left femoral artery and a left femoral arteriogram was performed. The wire was advanced throught the catheter and the catheter pulled out and a right femoral arteriogram was performed.
> 
> Findings: patent aorta, renal arteries and iliac arteries on both sides.
> left side: patent profunda, occlude SFA at origin. Popliteal occluded at the knee
> ...



I also agree with your codes based on the documentation. I will add that _if_ there was interpretation of the extremities (at least to the knee/femoral arteries) from the bifurcation injection, and then the catheter was advanced and more images taken/interpreted of the left lower extremity, you could add one 75774 code. This can be very subjective. Usually these extra injections are performed to complete the bilateral extremities. 

HTH


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