# Renal arterial procedure



## prabha (Jul 15, 2009)

Can anyone help me with the below procedure??

the supine position and both groins prepped and draped in sterile
fashion.
The skin was anesthetized with 1% lidocaine.
A micropuncture needle was used to access the left common femoral artery.
Using Seldinger technique, a 5 French vascular sheath was placed. Via the
sheath, a 5 French pigtail catheter was placed to the level of the
abdominal aorta and an abdominal aortogram was performed with attention
to the renal arteries.
Single bilateral renal arteries were identified.
Each of the renal arteries was selectively catheterized with a 5 French
Simmons I Glide catheter.  Pressure measurements were obtained. These
revealed no gradients. There was no evidence of osteal nor proximal
stenosis and the lack of pressure gradient further confirmed the
angiographic findings.
The right kidney measures approximately one-half the craniocaudal length
of the left kidney.
Given the discrepancy in the renal parenchyma, request had been made as
part of the consultation of this patient for renal vein renin sampling.
The right common femoral vein was punctured with a micropuncture needle
under ultrasound guidance. Using Seldinger technique, a 5 French vascular
sheath was placed. Via the sheath, a 5 French pigtail catheter was placed
both below and above the renal veins and inferior vena cava venous sample
obtained for renin levels.
The 5 French Simmons I Glide catheter was used to selectively catheterize
each of the renal veins and, again, selective renal vein renin sampling
was obtained.  Following the procedure, the catheter and sheath were
removed from both the right groin and left groin and pressure applied for
10 minutes. There was no postprocedural hematoma, nor change in the
distal vascular examination. The patient tolerated the procedure well and
was transported to his room in stable condition.
FINDINGS:
There is no evidence of stenosis involving either renal artery. The right
kidney is much more atrophied than the left and selective renal vein
renin sampling was sent for further analysis.


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## vikas.maheshwari (Jul 15, 2009)

Hi Prabha,

You can use these code

36245, 36245-59
75724-26
36011, 36011-59
75833-26, 59


Thanks,

Vikas Maheshwari
MBA-HCS, CPC-H


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## Jim Pawloski (Jul 15, 2009)

I agree with the codes, except for modifier 26, I don't believe it can be used in this manner, check your provider.  Also the code for venous sampling s&i is 75893 x 2


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## dpeoples (Jul 15, 2009)

prabha said:


> Can anyone help me with the below procedure??
> 
> the supine position and both groins prepped and draped in sterile
> fashion.
> ...




for diagnostic renal angiography
36245 (x2) modify per payor
75724
for venous sampling
36500 (x2) includes catheter placement
75893 (x2) includes diagnostic venography

apply modifier 26 to the 7000 series codes if the charges are for professional component (not facility) only.

HTH


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## prabha (Jul 15, 2009)

Thanks for all replies.....


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## MLS2 (Jul 16, 2009)

I also came up with
75724
36245x2
75893x2
36500x2


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