# Abdominal aortogram with peripheral runoff and..



## peeya

Can someone please help on how to code this procedure:

Procedure
1. Abdominal aortogram with peripheral runoffs
2. Left superficial femoral artery angiography
3. Left popliteal angiography
4. Left distal superficial femoral artery PTA and stenting

The right femoral artery was cannulated using the Seldinger technique and 6-French sheath was inserted. Thereafter, an abdominal aortogram with an Omniflex catheter was performed, with a runoff. Thereafter, attempted to get over the horn, after multiple tries with a catheter, angled catheter, Omniflex catheter, pigtail catheter, we were finally able to cannulate the left iliac artery. An over-the-horn sheath was placed. A Glidecath was advanced distally into the distal SFA region, angiography was performed. Thereafter, angioplasty, followed by a 6 x 16 mm self-expanding Lifescience stent was deployed, it was dilated with a Dorado balloon up to 14 atmospheres, with 0%residual stenosis.


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## Dorothy Steed

Was intent of the encounter to insert the stent or was it for the PTA with decision for stent after PTA determined need for stent?


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## peeya

The patient was taken to the cath lab for abdominal aortogram, peripheral runoff with possible angioplasty & stenting.


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## 10marty

I would code:

75630-26
36247 Left SFA
35470 Angioplasty
75962-26 
37205 Left SFA
75960-26
75774-26

Question whether the MD knew he was going to stent, or did he stent due to a poor result,  in order to bill the angioplasty.

See what others suggest.

MJ


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## peeya

As per the Doctor, stent was a possibility. Somebody told me to bill the following codes.

36247
75675-26
35494 LT
75992-26
37205
75960-26

Do you guys think it is correct?

Please help..!



75774


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## theresa.dix@tennova.com

*peripheral*

I would use codes below

75630 aortogram with runoff
36247 sfa
75710-59 unilateral extremity
37205 stent
75960 S & I
 I would not code the PTCA  because it is not documented that  it was unsucessful and they had to go on to do the stent.


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## dpeoples

peeya said:


> Can someone please help on how to code this procedure:
> 
> Procedure
> 1. Abdominal aortogram with peripheral runoffs
> 2. Left superficial femoral artery angiography
> 3. Left popliteal angiography
> 4. Left distal superficial femoral artery PTA and stenting
> 
> The right femoral artery was cannulated using the Seldinger technique and 6-French sheath was inserted. Thereafter, an abdominal aortogram with an Omniflex catheter was performed, with a runoff. Thereafter, attempted to get over the horn, after multiple tries with a catheter, angled catheter, Omniflex catheter, pigtail catheter, we were finally able to cannulate the left iliac artery. An over-the-horn sheath was placed. A Glidecath was advanced distally into the distal SFA region, angiography was performed. Thereafter, angioplasty, followed by a 6 x 16 mm self-expanding Lifescience stent was deployed, it was dilated with a Dorado balloon up to 14 atmospheres, with 0%residual stenosis.



here goes:
37205/75960 for the stent
36247 for the catheter placement
That is all I would code based on the information above. To code for diagnostic images, the physician must supervise/perform the injection (which is documented) and provide an interpretation (report findings) of said images (which is not documented). If there is an interpretation, the code selection depends on specific areas documented but would be chosen from the following codes in some combination.
75710
75716
75630
75625
75774

I would not code for the PTCA because it must be documented to be insufficientor ineffective, leading to stent placement, which it is not.

HTH


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## peeya

Findings:

Abdominal Aorta: The abdominal aortogram was performed. there was evidence of mild disease in the aorta. Renal arteries to be normal.

Right Lower extremity, right iliac - Normal

Right SFA: Mild to mmoderate disease. ________ and flow to the foot was preserved.

Left iliac - Normal

Left SFA: Distal, 100% occluded. ______ was preserved, with good flow to the ankle. Status post PTA & stenting of the left distal SFA, 4 x 6 x 16mm self-expanding Lifescience stent with 0% resudual stenosis.

So do I bill the following codes:

75716
75630
75774

please help!


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## dpeoples

peeya said:


> Findings:
> 
> Abdominal Aorta: The abdominal aortogram was performed. there was evidence of mild disease in the aorta. Renal arteries to be normal.
> 
> Right Lower extremity, right iliac - Normal
> 
> Right SFA: Mild to mmoderate disease. ________ and flow to the foot was preserved.
> 
> Left iliac - Normal
> 
> Left SFA: Distal, 100% occluded. ______ was preserved, with good flow to the ankle. Status post PTA & stenting of the left distal SFA, 4 x 6 x 16mm self-expanding Lifescience stent with 0% resudual stenosis.
> 
> So do I bill the following codes:
> 
> 75716
> 75630
> 75774
> 
> please help!



I think there are some technical details left out, for instance, where was the catheter end position for each and every injection? Without that information , all that I would code based on the above is 75630.

HTH


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## theresa.dix@tennova.com

exactly, and in order to bill the 75774 you need a cath placement. 36247 is a cath placement but you are billing 75710 with it. 75774 is a selective code and you do not have a cath placement to bill it.


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## peeya

Thank you all so such for your help.


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