# Renal Artery Stent



## peeya

Can some one help me code this procedure.. I am new to cardiology billing & totally confused with this one. 


PROCEDURE: After informed consent was obtained from the patient, the patient was premedicated and brought to the cath lab where she was sterilely prepped and draped and locally anesthetized. The right femoral artery was cannulated using a Seldinger technique and 6-French Judkins inserted and, thereafter, abdominal aortogram, bilateral renal angiography, and right selective renal angiography was performed. Thereafter a wire was advanced into the right renal artery, or a LIMA catheter, as an RDC catheter did not sit well at the ostium. A PTA with a 4 x 15 mm balloon was performed followed by a 6 x 14 mm Express renal stent, deployed at 8 atmospheres (5.75 mm) with a 0% residual stenosis. The procedure was tolerated without complication. The StarClose device was deployed successfully. 

FINDINGS
1. Abdominal aorta normal. 
2. Right renal artery, 80% to 90% mid stenosis. PTA followed by 6 x 14 mm Express stent deployed.
3. Left renal artery patent. 

PROCEDURES
1. Abdominal aortogram.
2. Selective right renal angiography. 
3. Right renal percutaneous transluminal angioplasty (PTA) and stenting.


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## Jim Pawloski

peeya said:


> Can some one help me code this procedure.. I am new to cardiology billing & totally confused with this one.
> 
> 
> PROCEDURE: After informed consent was obtained from the patient, the patient was premedicated and brought to the cath lab where she was sterilely prepped and draped and locally anesthetized. The right femoral artery was cannulated using a Seldinger technique and 6-French Judkins inserted and, thereafter, abdominal aortogram, bilateral renal angiography, and right selective renal angiography was performed. Thereafter a wire was advanced into the right renal artery, or a LIMA catheter, as an RDC catheter did not sit well at the ostium. A PTA with a 4 x 15 mm balloon was performed followed by a 6 x 14 mm Express renal stent, deployed at 8 atmospheres (5.75 mm) with a 0% residual stenosis. The procedure was tolerated without complication. The StarClose device was deployed successfully.
> 
> FINDINGS
> 1. Abdominal aorta normal.
> 2. Right renal artery, 80% to 90% mid stenosis. PTA followed by 6 x 14 mm Express stent deployed.
> 3. Left renal artery patent.
> 
> PROCEDURES
> 1. Abdominal aortogram.
> 2. Selective right renal angiography.
> 3. Right renal percutaneous transluminal angioplasty (PTA) and stenting.



36245, 75722 (no documentation for selective lt renal), 37205, 75960.
HTH,
JIm Pawloski, CIRCC


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## peeya

Please confirm if I am understanding this correctly. 

The correct CPT codes to bill for the above mentioned procedure are 36245, 75722, 37205 & 75960 but there is no documentation for the 36245 & 75722..

correct..?


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## donnajrichmond

There is documentation for 36245 and 75722.  - "right selective renal angiography was performed." and "Right renal artery, 80% to 90% mid stenosis."
What Jim is saying is that there is no documentaion for a selective left renal catheterization and angiogram.  Had there been, you would code 36245 x 2, 75724, and 37205 and 75960.  
Since there is no left selection, you would code 36245 only once, code 75722 instead of 75724, and the stent codes.  
If the angioplasty was not pre-dilating for the stent that could also be coded, but as documented I would not.  

And don't work really hard on figuring out the renal angiography coding because it changes come January!


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## Jim Pawloski

donnajrichmond said:


> There is documentation for 36245 and 75722.  - "right selective renal angiography was performed." and "Right renal artery, 80% to 90% mid stenosis."
> What Jim is saying is that there is no documentaion for a selective left renal catheterization and angiogram.  Had there been, you would code 36245 x 2, 75724, and 37205 and 75960.
> Since there is no left selection, you would code 36245 only once, code 75722 instead of 75724, and the stent codes.
> If the angioplasty was not pre-dilating for the stent that could also be coded, but as documented I would not.
> 
> And don't work really hard on figuring out the renal angiography coding because it changes come January!



Thank you Donna for clairifying why I didn't bill for the left renal artery.  I saw this late last night, so I just gave the codes.  And for the new codes, they are very interesting!
Have a great day,
Jim Pawloski, CIRCC


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## peeya

Thank you guys.. You are great.


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## Naomos

That was very informative for me as well.  I will be taking the CCC exam in December and I am trying to get all the information I can on the vascular studies.


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