# new to carotid angiography coding HELP!



## csorensen21@yahoo.com (Dec 28, 2015)

My doctors rarely do intervention with the carotid arteries. When they do I am completely stumped! HELP

Procedure:

1. Bilateral Carotid Angiography
2. Cerebral Angiography.
3. Aortic arch angiography
4. Angio-seal of the right femoral artery after confirming mid arterial stick with right common femoral angiography

Indication:

Staged procedure for left carotid stenting planning. The patient was consented. Timeout was performed. Risks and benefits were discussed with the patient. The risk of stroke, MI, bleeding were discussed with the patient. The patient was prepped according to protocol. Access was obtained from the right femoral artery using 5-french sheath. A diagnostic Judkins right was used to engage with the left innominate artery and using Glidewire was directed into the right common carotid artery. Selective angiography of the right common carotid artery with cerebral angiography with multiple angiographic images were performed. 

Catheter was withdrawn into the origin of the innominate artery and angiography of the right vertebral artery was performed. Then, subsequently, the catheter was directed into the left subclavian and angiography of the left subclavian and the origin of the left vertebral artery was performed.

We attempted to engage with the left carotid artery with some difficulty. We used a heah hunter catheter and a Glidewire was used to advance, it keeps pushing the catheter out. Finally, we were able to have a head hunter engage in the origin of the left common carotid artery that is bovine in oriign and originating from the right innominate artery. Angiography of the common carotid and the internal carotid arteries in addiction to cerebral angiography was performed. 

Omniflush catheter was advanced over guidewire and digital subtraction imaging of the aortic arch and origin of the great vessels was performed. 

Findings: 
1: Aortic arch appears to be within normal range type A
2. Bovine anatomy of the origin of the right innominate artery and the left common carotid artery was noted, no significant disease at the proximal segment of these vessels.
3. Patent right innominate artery and patent origin of the right vertebral artery. 
4. Patent right common carotid artery with no significant disease at the level of the bulb of the right internal carotid artery.
5. Cerebral angiography of the right system appears to be normal, both arterial and venous stasis with complete opacification  of the sinus and venous phase without any abnormality noted. 
6. Patent left subclavian artery. 
7. Patent left vertebral artery.
8. Bovine origin of the left common carotid artery. 
9. Patent left common carotid artery.
10. Severe stenosis of the left iternal carotid artery, which appears to be at least 90% nascet criteria.
11. Normal cerebral flow and normal cerebral circulation noted on angiography.

Final Conclusion:
1. Severe stenosis of the left common carotid artery, correlating with the CT angiography appears to be 90% by NASCET criteria.
2. Patent right vertebral and left verterbral arteries.
3. Normal Cerebral circulation based on cerebral angiography.
4. Angio-seal of the right femoral artery without any immediate problem. 
5. No immediate complication  and stable neruologically prior to discharge.


HELP me please


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## smiller (Dec 30, 2015)

Hi Carrie - This looks like 36223-50 (intracranial and extracranial views) and 36225-51 (selective left subclavian angiography).  The aortic arch angiography is included in these.


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## csorensen21@yahoo.com (Dec 30, 2015)

smiller said:


> Hi Carrie - This looks like 36223-50 (intracranial and extracranial views) and 36225-51 (selective left subclavian angiography).  The aortic arch angiography is included in these.



Thank you so much!!!


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## Jim Pawloski (Jan 3, 2016)

csorensen21@yahoo.com said:


> My doctors rarely do intervention with the carotid arteries. When they do I am completely stumped! HELP
> 
> Procedure:
> 
> ...



You have 36223-50, 36226-50, G0269.

Thanks,
Jim Pawloski, CIRCC


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