# Carotid Angiography



## OPENSHAW (Mar 21, 2014)

Please Help, need help coding this!  I have listed what was done below!

Operation performed:  Selective coronary angiography, left heart catheterization, and bilateral carotid angiography.

Description of the procedure:  The patient was brought to the Cath Lab and the right groin was prepped and draped in the usual fashion.  A 2% lidocaine was used to deliver local anesthesia to the right groin.  A Cook needle was used to access the right common femoral artery under fluoroscopic guidance.  A #5 arterial sheath was placed in the right common femoral artery.  A#5 French JL4 catheter was advanced over the wire under fluoroscopic guidance to the aortic root and the wire was removed and the catheter was flushed.  The left main was selectively engaged and multiple views were taken from the left coronary artery, left circumflex, and left anterior descending artery.  The catheter was disengaged from the left main and was exchanged over the wire to a #5 French JR4 which was advanced to the aortic root and the wire was removed and the catheter was flushed.  The right coronary artery was selectively engaged under fluoroscopic guidance and multiple views were taken.
The JL4 catheter was pulled and was selectively engaged to the right common carotid artery and then moved to the left common carotid artery.  Multiple views were taken from the bilateral carotid arteries.  The catheter was removed over the wire and the arterial sheath was removed manually.

Findings:
1.  The left main was normal and free of disease.
2.  The left anterior descending artery was free of any significant stenosis and showed marked plaques.  
3.  The left circumflex artery was free of any significant stenosis and shows marked plaques.  Some distal LAD pruning was noted.
4.  The RCA was free of any significant stenosis.
5.  The right internal carotid artery was totally occluded and the stump was noted.
6.  The left internal carotid artery showed a heavily calcified lesion and intermediate stenosis of 50% to 60%.
7.  The bilateral common carotid arteries were ok.

Would I code this as 36224-50 and code 93458-26.  Patient has Diagnosis, carotid disease 433.10 and CAD 414.00.

Would I bill:    36224-50, DX code 433.10
                   93458-26, DX code 414.00

Would I bill code 36226 since the doctor went into the right vertebral artery.  I did not code this based on the report.
Do I code 36222-50, since the doctor started in the common carotid artery?
CODE 36222 DOES BUNDLE TO CODE 36224.

Thank yaw for your help!!!!!!


----------



## dpeoples (Mar 21, 2014)

OPENSHAW said:


> Please Help, need help coding this!  I have listed what was done below!
> 
> Operation performed:  Selective coronary angiography, left heart catheterization, and bilateral carotid angiography.
> 
> ...



I would not code 36224-50 for the bilateral carotids, documentation does not support internal carotid selection. I would code 36222-50 (no intracranila interpretation). 
I also would not code 93458, the documentation does not support catheter placement into the left ventricle. I would code 93454.

I don't see selection or interpretation of the Rt vertebral artery. Did I miss that?
The ICD9 codes seem correct to me.

HTH


----------



## OPENSHAW (Mar 21, 2014)

Danny, I truly thank you for your help.  It means a lot!  I am looking at the doctors diagram and it states at the top Carotid Angiography.  It has a picture of the carotid and it is circled at right vertebral artery, then I see the common but it is marked at internal carotid artery on the right and left side, by the left side the dr. wrote 50-60% and on the right side at internal carotid it is marked.  I guess my question is since the dr. went into the common carotid artery this is why we would bill for code 36222.  He found occlusion in the right and left internal carotid artery which is marked on the diagram he turned in. You said since he does not show he went in with a catheter placement in the left ventricle, you would use code 93454.


----------

