# upper extremities angiography



## churst21

Procedure and risks were explained and informed consent obtained. Conscious sedation administered and 
continuous physiological monitoring by nursing staff. The right groin was prepped, draped, and anesthetized in the usual 
fashion. Right common femoral artery was punctured with a 19-gauge singlewall needle and a guidewire advanced. A 
5-French sheath was placed. A 5-French HN2 catheter was advanced and used to selectively catheterize the left and 
right subclavian arteries and angiography obtained. The catheters were then selectively advanced down to the distal 
brachial artery for improved visualization of distal upper extremity flow bilaterally.

Findings:
RIGHT UPPER EXTREMITY angiography is essentially unremarkable. There is no evidence of stenotic or occlusive 
disease and no thrombosis. There is a dominant ulnar artery that supplies the the superficial palmar arch while the radial 
artery is more diminutive in caliber supplies the intact but diminutive deep palmar arch. No significant disease of the 
common and proper palmar digital arteries.

LEFT UPPER EXTREMITY angiography is unremarkable from the level of the aortic arch through the left 
subclavian/axillary/brachial artery. Normal brachial artery bifurcation and unremarkable proximal aspects of the ulnar and 
radial arteries.

There is however initially lack of any definitive flow seen to the hand so a 3-French microcatheter was advanced the 
proximal forearm to the level of the brachial bifurcation and digital angiography obtained from this point on. There is once 
again sluggish distal flow of the forearm vessels. Similar to the right arm there is a dominant ulnar artery this is a vessel 
which distal sluggish flow. There appears to be two focal modest stenoses of the ulnar artery around the level of the wrist 
and termination of the vessel at the proximal arch level feeding third fourth and fifth dorsal metacarpal arteries with lack of 
an intact/patent superficial palmar arch. Similar to the right arm there is more diminutive radial artery but it feeds an intact 
deep palmar arch as well as diminutive metacarpal vessels demonstrated.

i have an idea but kind of confused about the brachial artery?


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## Jim Pawloski

churst21 said:


> Procedure and risks were explained and informed consent obtained. Conscious sedation administered and
> continuous physiological monitoring by nursing staff. The right groin was prepped, draped, and anesthetized in the usual
> fashion. Right common femoral artery was punctured with a 19-gauge singlewall needle and a guidewire advanced. A
> 5-French sheath was placed. A 5-French HN2 catheter was advanced and used to selectively catheterize the left and
> right subclavian arteries and angiography obtained. The catheters were then selectively advanced down to the distal
> brachial artery for improved visualization of distal upper extremity flow bilaterally.
> 
> Findings:
> RIGHT UPPER EXTREMITY angiography is essentially unremarkable. There is no evidence of stenotic or occlusive
> disease and no thrombosis. There is a dominant ulnar artery that supplies the the superficial palmar arch while the radial
> artery is more diminutive in caliber supplies the intact but diminutive deep palmar arch. No significant disease of the
> common and proper palmar digital arteries.
> 
> LEFT UPPER EXTREMITY angiography is unremarkable from the level of the aortic arch through the left
> subclavian/axillary/brachial artery. Normal brachial artery bifurcation and unremarkable proximal aspects of the ulnar and
> radial arteries.
> 
> There is however initially lack of any definitive flow seen to the hand so a 3-French microcatheter was advanced the
> proximal forearm to the level of the brachial bifurcation and digital angiography obtained from this point on. There is once
> again sluggish distal flow of the forearm vessels. Similar to the right arm there is a dominant ulnar artery this is a vessel
> which distal sluggish flow. There appears to be two focal modest stenoses of the ulnar artery around the level of the wrist
> and termination of the vessel at the proximal arch level feeding third fourth and fifth dorsal metacarpal arteries with lack of
> an intact/patent superficial palmar arch. Similar to the right arm there is more diminutive radial artery but it feeds an intact
> deep palmar arch as well as diminutive metacarpal vessels demonstrated.
> 
> i have an idea but kind of confused about the brachial artery?



You have 36217-rt, 36217 lt-59, 75616.
HTH,
Jim Pawloski, CIRCC


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## meganbruce

*Upper Extremities Angiography*

_You have 36217-rt, 36217 lt-59, 75616.
HTH,
Jim Pawloski, CIRCC _


Jim - what is 75616?


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## donnajrichmond

mbruce36 said:


> _You have 36217-rt, 36217 lt-59, 75616.
> HTH,
> Jim Pawloski, CIRCC _
> 
> 
> Jim - what is 75616?



I'm pretty sure he means 75716 - bilateral extremity angiography. 

I would code just a bit differently. 
I agree on the right side - 36217 (innominate to subclavian/axillary to brachial). 
But on the left I would code 36216-59  (subclavian/axillary to brachial
And 75716 for the S & I.


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