# Angiography - ascending aorta



## Shay2025 (Jan 26, 2012)

5 french omni catheter was placed in the ascending aorta and arch and carotid digital subtraction angiography wain LAO and RAO was performed (36200/75600???)

Subsequently the RCC artery was selected with the JB2 catheter and AP lateral and oblique was repeated. The LCC artery was not immediately easily selected and the arch view included excellent imaging of the proximal left internal carotid artery and instead then, the catheters were exchanged back to the Omniflush catheter which was placed at T12 and abd. digital substraction angiography was performed. Utilizing this as a road map the right renal artery was selected and the right renal artery digital subtraction angiography and intra-arterial manometry were performed. (how do you code this??? )

Initially passing the mircopuncture needle which was utilized, there was a bit of resistance, such that only the inner sheath was utilized initially and there was back fluching and a right iliofemoral digital subtraction angiogram was performed which showed rather extensive external iliac artery plaque which did not appear to be hemodynamic significance.. the femoral artery appeard to be smooth and widely patent. the equipment was removed and Starclose applied and pt taken to the recovery room in stable condition. ( how do you code this???)


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## dimmitta (Jan 26, 2012)

This doesn't seem to be the complete op note, so best guess?

75650 - Arch Study
36216 - Selective Right Common Carotid
75676 - Unilateral Common Carotid S&I
36251 - Selective cath of main renal artery (includes cath placement and S&I), unilateral

the last paragraph has me stumped...i cannot tell where the access for all this is...i would be inclined to possibly give an extremity picture 75710. This is best guess, with a lot of supposition on my part. Without knowing access site, type of arch/position of great vessels, this is the best I can do, but hopefully it will give you an idea of where to look at least


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## Jim Pawloski (Jan 26, 2012)

dimmitta said:


> This doesn't seem to be the complete op note, so best guess?
> 
> 75650 - Arch Study
> 36216 - Selective Right Common Carotid
> ...



The last part is for the closure device, so you cannot bill for the peripheral (75710).  You bill G0269.  I agree with your other codes.
Thanks,
Jim Pawloski, CIRCC


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## Shay2025 (Jan 27, 2012)

thx soo much to the both of you... I work for a HMO ... and this case really stumped me. The  provider actually coded the following for this case:
37202
75896
75710
36245
75722
36216
75676
36215
75650
36216
75676
36215
75650
36200
75600

 All of which they used mod. -59 to justify it being seperately distinct. I though it was a bit much for this case however this is not my specialty. 
Is it ok to add you guys to my contacts just in case I come across something similar to this case?


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## dimmitta (Jan 27, 2012)

Wow, that is a bit much lol! Good call catching this one before it went out! Absolutely you can add me as a contact. I am always happy to help whenever I can.


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## Shay2025 (Jan 27, 2012)

thx soo much.... I will definitely be keeping in touch . CIRCC's are to me some of the most intense coding specialists.... I can't wrap my head around cardio for anything in the world.  Hats off to all CIRCC's


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## dpeoples (Jan 27, 2012)

Shay2025 said:


> thx soo much to the both of you... I work for a HMO ... and this case really stumped me. The  provider actually coded the following for this case:
> 37202
> 75896
> 75710
> ...



Wow is right! There must be more to this case than what you were given (report wise), I see no way anyone would code 37202/75896 on the above report. The rest could just be someone not understanding the rules regarding selective cath placements and injections. They seem to have coded for each vessel, lower order and higher order, each time they moved the cath or injected contrast. They should be thankful you caught this before it went out the door. The question is, how many other similar cases are there? Seeing this makes me feel more secure in my job!

HTH


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