# Help coding this please



## lindseyj (Aug 27, 2009)

75680
75650
75665
75685
75685
75710

this is what our provation came up with. I have never billed for one of these so does anyone disagree and do you beleive this is enough doumentation?
thanks so much


Procedure:
.
Carotid Arteriography
Indications:
Carotid stenosis documented on ultrasound.
Procedure Medications:
Total IV Fluids Administered
- IV Fluids: 0.9NaCl IV started @ 50 ml/hr IV Fluids
Local Anesthetic to right groin 7.5 ml Lidocaine 2% >Initial mL, local infiltration total dose.
Heparin 2000 units IV
Complications:
No immediate complications. Estimated blood loss minimal.
Patient History:
Pt Status: Admission Status: Outpatient Referral
Pt Status: Patient Admission Type >> Outpatient
Pt Status: Insurance Payor: Commercial
Hx/Risk Factors: Peripheral Vasc: Percutaneous intervention to extremities
Hx/Risk Factors: Heart Disease: Hx of CAD
Hx/Risk Factors: Hx of Smoking: Yes-Former
Hx/Risk Factors: Pulmonary Disease: COPD
Hx/Risk Factors: Dyslipidemia
Hx/Risk Factors: Other Cardiac: Cardiomyopathy/Heart Failure
Previous Procedures: Cardiac Cath - Positive 04-01-2009
Previous Procedures: Peripheral Perc Intervention: Atherectomy 06-18-2009
Hx/Risk Factors: Heart Disease: MI: >7 days ago
Plt Aggregation Inhibitor-Clopidogrel (Plavix) > Yes
Aspirin-Aspirin > Yes
Lipid Lowering - Statins-Statins (any) > Yes
Beta Blocker-Beta Blocker > Yes
ALLERGIES: NKDA
Description of Procedure:
Fluoroscopy
- Fluoroscopy time: 6.9 minutes.
Devices Used
- Meditech/Namic Fixed Core 3mm J .035" 145 cm
- Terumo Standard 5 Fr.
- Boston Scientific 4 Fr. JR 4.0 cm
- V+Pad
- Namic 12 cc Control
Approach:
- Right femoral artery approach. Access method: Percutaneous puncture.
- Right femoral artery approach. Access method: Percutaneous puncture.
Left Heart Catheterization
- At the conclusion of the procedure, the right femoral artery sheath was removed. Hemostasis was obtained with
manual compression.
Findings/Interventions:
Head and Neck Arteriography Injections
- The pigtail catheter was advanced into the aortic arch and an injection of contrast was performed. The JR4 catheter was advanced into the brachiocephalic trunk and an injection of contrast was performed to better visualize
distal vasculature. The JR4 catheter was advanced into the left common carotid artery and an injection of contrast
was performed to better visualize distal vasculature.
Aorta and Major Vessels
- There was a normal aortic arch present.
Head and Neck Arteriography
- Aorta
There were no obstructing lesions in the aortic arch. Blood flow appeared normal.
- Right
There was a 10% discrete atherosclerotic stenosis in the brachiocephalic artery. There was a 100% discrete
atherosclerotic stenosis in the right external carotid. There was a 20 to 30% discrete atherosclerotic stenosis in the
proximal right internal carotid. There were no obstructing lesions in the distal right vertebral artery. Blood flow
appeared normal.
- Left
There was a 10% discrete atherosclerotic stenosis in the proximal left subclavian artery. There were no
obstructing lesions in the left internal carotid artery. Blood flow appeared normal. There were no obstructing lesions
in the left common carotid. Blood flow appeared normal. There were no obstructing lesions in the left common
carotid artery. Blood flow appeared normal. There were no obstructing lesions in the left common carotid at its
junction with the internal and external carotid. Blood flow appeared normal. There were no obstructing lesions in
the left external carotid. Blood flow appeared normal. There were no obstructing lesions in the distal left vertebral
artery. Blood flow appeared normal.

Impression:
.
There were no obstructing lesions in the left internal carotid.
Mild left upper extremity atherosclerotic vascular disease.
There was a normal arch present.
10% stenosis of the brachiocephalic artery.
Occluded right external carotid.
20 to 30% stenosis of the proximal right internal carotid.
10% stenosis of the proximal left subclavian artery.


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## Jim Pawloski (Aug 27, 2009)

lindseyj said:


> 75680
> 75650
> 75665
> 75685
> ...



First code the catheter placement
36215- 1st order Brachiocephalic
36215-59 -  1st order Lt Common Carotid
No code for the Catheter Placement Aorta since a selective run was performed.

Now for the S&I
75650 - Arch Arteriogram
75680-59 - Bilateral cervical carotid angio.
75671-59 - Bilateral Cerebral angio.
75685 - ? bilateral Vertebral angio/ Described from arch injection

Extremity angio bill has to be the complete extremity, I don't feel that it can be billed.

Hopes this helps!


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## dpeoples (Aug 28, 2009)

Jim Pawloski said:


> First code the catheter placement
> 36215- 1st order Brachiocephalic
> 36215-59 -  1st order Lt Common Carotid
> No code for the Catheter Placement Aorta since a selective run was performed.
> ...




I agree, but don't see the need for the 59 modifier. Am I missing something?

HTH


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## Jim Pawloski (Aug 28, 2009)

dpeoples said:


> I agree, but don't see the need for the 59 modifier. Am I missing something?
> 
> HTH



I may have overdone modifier -59, but is the modifier needed to distinguish the separate vessles? Rt and Lt could be used instead depending on insurance company.


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