# peripheral angiography



## gjja (Jul 30, 2013)

I am learning peripheral angiography and am finding it to be a great challenge. If anyone can help me to navigate through one of my docs I would appreciate any assistance.

"After an overnight fast..pt brought to cath lab. Patient was prepped and draped...
A 5 French sheath was then introduced utilizing modified Seldinger technique into the right femoral artery. Abdominal aorta and bilateral iliac angiography was performed using an omniflush catheter. An angled wire was advanced into the contralateral iliac artery utilizing a catheter over the aortic horn and an internal mammary catheter was placed selectively in the contralateral external iliac artery. Selective Angiography of the left lower extremity was performed. Selective angiography of the right lower extremity was performed via the right femoral arterial sheath. An intervention was performed to the left SFA and the left external iliac as described after a sheath exchange was done. 
PCI to lesion within the proximal left external iliac artery. Stenosis was successfully reduced. Balloon expandable stent.
PCI to lesion within the ostial left superficial femoral artery. Stenosis was successfully reduced. Cutting balloon angioplasty.
PCI to lesion within the mid to distal left superficial femoral artery. Stenosis successfully reduced. Self expanding stent.

The codes I came up with are 75630-26,36200,75716-26,36246,37226,37221. After trying to find the bundling relationships within them; I think 37226,75630-26 may be appropriate.

I am trying to get a clearer picture on how to read the report if anyone can be of assistance to help me pull out the pertinent information I would be grateful.


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## jambam4 (Jul 30, 2013)

*peripheral angiograpy*

it is indeed difficult when you are first starting to code stuff like this.  I do cardiology, but a few of my docs will do peripheral angiography/interventions.  

what is your email address and i will send you a copy of one of my cheet sheets i made from Dr Z(which i purchased, also a good investment for any coder).  also, who is the payor for this procedure you posted?  some of the R&I will be bundled with the cath/stent codes, so you can't bill if its MC/MIL/Medicaid.

also, you might want to invest in purchasing the Cardiology/Cardiothoracis surgery/Vascular Surgery coding companion by Optum/Ingenix.  it's the bomb.  and it lists all the of the CCI edits for each cpt code.  it's been a lifesaver for me.  EncoderPro helps a bunch, too.  both are a bit pricey.


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## gjja (Jul 30, 2013)

*thank you*

Thank you so much for your help! My email address is gjjaaron@juno.com. I will also look into the book you mentioned.


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## jewlz0879 (Jul 31, 2013)

You can bill 37226 & 37221. You can't bill the selective cath positions (i.e. 36245-36248) as they are now bundled with the Peripheral interventions. 

If your physician did just the selective cath placements with angio and no peripheral intervention, then you could capture the appropriate cath codes. 

Ex: Via right transfemoral approach, aortogram performed and cath brought down for bilateral pelvis obliques to evaluate the left iliac and proximal femoral artery followed by selective unilateral LLE (left lower extremity) angio from the contralateral common femoral artery. 

36246, 75625-26, 75710-26

I agree with 75630-26,59 IF there was ONE cath placement: aortogram with complete bilateral run-off = 75630. 

If there were multiple cath placements...

If the doc did the aortogram (75625-26) and then selective cath placements in the iliacs (75716-26). 

HTH


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