# angiogram via sheath



## mabar1571 (Aug 8, 2011)

senerio is pt.had angioplasty of rt.tpt w.thrombolysis and tpa infusion was continued overnight w.inplace infusion cath.  next day infusion cath.removed and they did angiogram of rt.lower ext.via sheath.  can I bill for this angiogram?  what code would you use?  besides findings of rt.lower extrem. they did mention "distal aorta w/o obstruction"  I'm inclined to bill just 75710, maybe w.a -76.  and w/o a cath.code would this get paid?
any suggestions would be most helpful.


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## K.hancin (Aug 8, 2011)

Disclaimer: I passed the CPC exam in January but have no work experience in coding. With that being said you might also consider:

37201 infusion for thrombolysis 
75896
75898 follow-up angiography

Good Luck!
Karen


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## Jim Pawloski (Aug 8, 2011)

mabar1571 said:


> senerio is pt.had angioplasty of rt.tpt w.thrombolysis and tpa infusion was continued overnight w.inplace infusion cath.  next day infusion cath.removed and they did angiogram of rt.lower ext.via sheath.  can I bill for this angiogram?  what code would you use?  besides findings of rt.lower extrem. they did mention "distal aorta w/o obstruction"  I'm inclined to bill just 75710, maybe w.a -76.  and w/o a cath.code would this get paid?
> any suggestions would be most helpful.



On this one, you need to know where was entry point, where did the catheter go, what was imaged, and what was done.  You can bill for catheter placement, unilateral angio (?), thrombolysis (37201/75896), and follow-up angio for the next day (75898).
HTH,
Jim Pawloski, CIRCC


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## mabar1571 (Aug 9, 2011)

problem is they removed infusion cath.before they did angiogram, through sheath.  Though, the thrombolysis was continued from the previous day through the indwelling cath.  So, the thrombolysis was done after pt.left cath lab and was on floor.  

Maybe the thrombolysis while pt.was on floor could be billed by inpt service?  And as to -75898, it sounds like it would be a great code to use--if they hadn't did the angiogram through a sheath instead of a cath.  

FYI--I did bill for the thrombolysis (37201,75896) the previous day.

Still think 75710 is my best option.


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## dpeoples (Aug 9, 2011)

mabar1571 said:


> problem is they removed infusion cath.before they did angiogram, through sheath.  Though, the thrombolysis was continued from the previous day through the indwelling cath.  So, the thrombolysis was done after pt.left cath lab and was on floor.
> 
> Maybe the thrombolysis while pt.was on floor could be billed by inpt service?  And as to -75898, it sounds like it would be a great code to use--if they hadn't did the angiogram through a sheath instead of a cath.
> 
> ...



I admire your strict interpetation of the code description but....even though the catheter was removed prior to injection, 75898 still applies IMO. The intent of the code is _*follow up angiography *_through the existing "access" ie not a new stick. In this instance the sheath acts as a catheter for the contrast injection.

from Dr Z's Diagnostic & Interventional Cardiovascular Coding Reference 2011 edition
" Do not code a diagnostic angiogram code (ie 75710) when a catheter follow up angiogram of the leg is performed; use 75898. This also applies to follow up angiograms on subsequent days during prolonged infusions."

He makes no mention that it must be the same catheter as the one placed for infusion.  

Note: the infusion codes (37201/75896) should only be billed once for the duration of this treatment.

HTH


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