# Help Angiography note



## Melonyw (Jul 28, 2009)

I am new to this, and this seems to be the hardest for me to get.


Procedures Performed:
Bilateral AIF with runoff
Abdominal aortogram

Single access was made into the right femoral artery the cath was passed over the guidewire thriough the protective sheath in the groin and up into the abdominal aorta where the guidwire was removed and multiplane injection of contrast was recorded, Another cath was then inserted over a guidewire and advanced into the common iliac artery where multiplane injection of contrast was recorded. Contrast was injected via the aterial sheath in the right leg, and images were recorded of this lower extremity. Contrast was injected via the arterial sheath in the left leg, and images were recorded of the lower extremity.

Findings:
Aortogram: This vessel is normal in size. There is no aneurysm noted.
Right Renal Artery: Mild nonobstructive disease.
Left Renal Artery: There is mild disease in the ostial segment. The vessel divides into two large branches in the proximal segment.
Left Upper Leg:
Common iliac artery: mild disease
Superficial Femoral Artery: 100% proximal reconstitutes distal segment by collaterals. PTA of left SFA using a long glide cath and angled glidewire attempt was made to cross the lesion without success, therfore PTA attempt was abandoned.
Left Lower Leg:
Popliteal artery: widely patent with 3-vessel runoff.
Right upper leg: Common Iliac artery: mild disease
Common femoral artery: 100% occuled: reconstitutes at the distal SFA.
Right Lower Leg: 
Popliteal Artery: Widely patent with 3-vessel runoff.


Here is the problem I have, I dont know the correct modifier usage I can come up with the codes and I can put the cath placements with the S&I its just the modifiers and the order of the cath placements. Doesnt start with the highest and go down? 

Here is what I have:

36247-35474-74   I added 74 because was procedure was done Outpatient
36140-59 75716-26 Do I need to add 59 mod to these?
36200-59 75625-26

Thank you all so much for the help, I can read and read but there is nothing like actually seeing the op notes worked out.


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## Jim Pawloski (Jul 28, 2009)

Melonyw said:


> I am new to this, and this seems to be the hardest for me to get.
> 
> 
> Procedures Performed:
> ...




The dictation leaves a lot of questions on catheter placements, so I am somewhat guessing on these.  I work in Interventional Radiology as a technologists, so my answers is going on my experience.

First, modifier 74 is used when a procedure is discontinued out patient procedure after anesthesia is given.  The procedure was performed, so that modifier cannot be used.

Since an attempted PTA was done, and a catheter made it into the lt SFA, the Catheter placement code is 36247.  Since a selective code is used, the Catheter placement- aorta cannot be used.  Code for Abdominal aorta S&I is 75626.

Bilateral extremity run-off is 75716.

I hopes this helps you out.


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## aforsythe (Jul 28, 2009)

I was wondering what would you bill if the report states: 

Despite balloon angioplasty there was a suboptimal result; hence an ICAST stent was then deployed.  There was a 0% residual stenosis.  The stent was post-dilated using an 8 mm balloon.  There was an excellent angiographic result.


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## Jim Pawloski (Jul 28, 2009)

aforsythe said:


> I was wondering what would you bill if the report states:
> 
> Despite balloon angioplasty there was a suboptimal result; hence an ICAST stent was then deployed.  There was a 0% residual stenosis.  The stent was post-dilated using an 8 mm balloon.  There was an excellent angiographic result.



You would bill for the stent placement.


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## Jim Pawloski (Jul 28, 2009)

aforsythe said:


> I was wondering what would you bill if the report states:
> 
> Despite balloon angioplasty there was a suboptimal result; hence an ICAST stent was then deployed.  There was a 0% residual stenosis.  The stent was post-dilated using an 8 mm balloon.  There was an excellent angiographic result.



You would bill for the stent placement, and the angioplasty, because of the failure of the angioplasty.


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## dpeoples (Jul 29, 2009)

Melonyw said:


> I am new to this, and this seems to be the hardest for me to get.
> 
> 
> Procedures Performed:
> ...




The documentation is not clear on a couple of points, but here goes:

36200  for this(  "_cath was passed over the guidewire thriough the protective sheath in the groin and up into the abdominal aorta")_

36140-59 for this ("_Contrast was injected via the arterial sheath in the left leg, and images were recorded of the lower extemity")_

75716 (26) no modifier 59 warranted
75625(26) no modifier 59 warranted

this statement lacks enough information to code accurately...
"_PTA of left SFA using a long glide cath and angled glidewire attempt was made to cross the lesion without success, therfore PTA attempt was abandoned"._ 

... there is no mention of the origin of the long glide cath, it could be from the left leg sheath, hince no third order selection (ipsilateral)

the attempted PTA does not warrant charging IMO because the attempt was abandoned without a balloon being placed or even opened (it is not documented).

HTH


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## Jim Pawloski (Jul 29, 2009)

dpeoples said:


> The documentation is not clear on a couple of points, but here goes:
> 
> 36200  for this(  "_cath was passed over the guidewire thriough the protective sheath in the groin and up into the abdominal aorta")_
> 
> ...



Sorry to disagree with you, but at the beginning of the report, it is stated that there is a single access in the rt femoral artery.  There for the lt leg has to be a third order cathetrization.
I agree with you that since PTA was abandoned, it cannot be billed.


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## dpeoples (Jul 30, 2009)

Jim Pawloski said:


> Sorry to disagree with you, but at the beginning of the report, it is stated that there is a single access in the rt femoral artery.  There for the lt leg has to be a third order cathetrization.
> I agree with you that since PTA was abandoned, it cannot be billed.



Hey No problem,
Like I said, there are a couple of points that are not clear enough to me for accuracy, that is one of those points. If it were my phycician, I would ask for a document revision.


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## Melonyw (Jul 30, 2009)

*Thank you ALL*

Thank you all for the help. I really appreciate it more than all of you all know!!
This helps me learn more than any reading could. I am trying to teach myself and its driving me crazzy.


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