# Cross over technique with run off



## bhong (Dec 11, 2009)

Hi to all,

    Need your opinion on how to code the following;
1. Selective angiography of right common iliac.
2. Selective angiography of the right femoral artery with runoff to the right lower extremity using a cross-over technique.
3. Selective angiography of the right popliteal artery with a runoff to the right lower extremity using a cross-over technique.

I do appreciate all your help.

Thanks

Bhong


----------



## Jim Pawloski (Dec 14, 2009)

bhong said:


> Hi to all,
> 
> Need your opinion on how to code the following;
> 1. Selective angiography of right common iliac.
> ...



First, where did the catheter go?  Was it placed in each of the vessels or just at the rt common iliac, and where was the entry point.  I will make a assumption that it was from the left femoral artery since you say cross over technique.  Otherwise I would say 75710 for rt extremity angio.

I hope thats helps,
Jim Pawloski


----------



## vsmith (Dec 14, 2009)

the selectively code for popiteal artery is the 3rd oder so this would be 36247 and unilateral extrem 75710,26. thanks vick


----------



## bhong (Dec 14, 2009)

Hi,
   You guess it right Jim, the point of entry was on the left Femoral artery, and selective angiography was obtained on the right commom iliac artery with runoff to the right lower extremity. is it right to use code 36246 and 75630 26 for it? and what about the selective angiography of the right femoral artery with runoff to the right lower extremity using a cross-over technique could I still use the 75630 26 but with modifier 59 on it or the 75710 26 59, the wire was then advance to mid superficial femoral when the angio was taken.

   I really get confused with the runoff and the cross-over techniques, i really appreciate your help on this.

Thank you.

Bhong


----------



## Jim Pawloski (Dec 16, 2009)

bhong said:


> Hi,
> You guess it right Jim, the point of entry was on the left Femoral artery, and selective angiography was obtained on the right commom iliac artery with runoff to the right lower extremity. is it right to use code 36246 and 75630 26 for it? and what about the selective angiography of the right femoral artery with runoff to the right lower extremity using a cross-over technique could I still use the 75630 26 but with modifier 59 on it or the 75710 26 59, the wire was then advance to mid superficial femoral when the angio was taken.
> 
> I really get confused with the runoff and the cross-over techniques, i really appreciate your help on this.
> ...




First, you code where the catheter went, not the wire.  So In this case, the catheter was in the left common iliac artery.  That is a first order catherization which is coded 36245.  You lose the aortic catheterization when the catheter goes selective. I would bill the S&I part 75710, since they are looking at the extremity.   So remember, for the "cross-over" or "over the horn", common iliac on the contralateral side is first order, external iliac- common femoral is second order, sfa is third order.
Hope that helps you out.
Thanks,
Jim Pawloski


----------



## dpeoples (Dec 16, 2009)

Jim Pawloski said:


> First, you code where the catheter went, not the wire.  So In this case, the catheter was in the left common iliac artery.  That is a first order catherization which is coded 36245.  You lose the aortic catheterization when the catheter goes selective. I would bill the S&I part 75710, since they are looking at the extremity.   So remember, for the "cross-over" or "over the horn", common iliac on the contralateral side is first order, external iliac- common femoral is second order, sfa is third order.
> Hope that helps you out.
> Thanks,
> Jim Pawloski



Based on the information given I agree with Jim, all that is documented is 
36245/75710.

HTH


----------



## bhong (Dec 18, 2009)

Hi,

   Yes! you are right, now i understand it more, maybe i was intimidated by the word "cross-over and runoff" so i was hesitant to use it. Jim THANK YOU very much for that enlightenment. 

 Hope to hear from you in my future queries...

Again Thank You!


Bhong


----------

