# peripheral coding



## karbaker (May 24, 2012)

right iliac angiography.
arch aortography
bilateral selectvie carotid angiography
selective left subclavian artery angiography.

femoral artery cannulated and flushed , guide wire advance to right iliac angio performed using digital subtraction angiography, occluded right internal iliac and right external iliac.  advanecd guidewire  and performed arch and bilateral cerebral corotid angiography  as well as sublclavian angiography then sheath removed and flushed

i am confused on how to code this.


----------



## dpeoples (May 24, 2012)

karbaker said:


> right iliac angiography.
> arch aortography
> bilateral selectvie carotid angiography
> selective left subclavian artery angiography.
> ...



Can you provide a report?


----------



## karbaker (May 24, 2012)

yes, how do I get this to you.

kbaker@ccvmg.com


----------



## dpeoples (May 24, 2012)

karbaker said:


> yes, how do I get this to you.
> 
> kbaker@ccvmg.com




The easiest way I can think of is to copy and paste everything on the report except the patient's identifiers. Just post (paste) on this topic when you reply.

HTH


----------



## karbaker (May 24, 2012)

Page 1 of2 
DATE OF PROCEDURE: 05/17/2012 
NAME OF PROCEDURE: 

1. Right iliac angiography. 

2. Arch aortography. 

3. Bilateral selective carotid angiography. 

4. Selective left subclavian artery angiography. 

INDICATION FOR PROCEDURE: 69-year-old gentleman with 
multiple vascular risk factors, diabetes, tobacco use, known coronary artery disease with previous bypass operation and severe peripheral 
arterial disease with prior lower extremity atherectomy procedures. The 
patient has known bilateral carotid disease and on a recent noninvasive CT 
angio he demonstrated evidence of significant disease progression with a 
high-grade lesion in the right carotid. Therefore, arch and carotid angiography was recommended for further evaluation in anticipation of the need for intervention. 
DESCRIPTION OF PROCEDURE: After proper explanation of the procedure, its indications, risks and benefits, an informed consent was obtained from Mr. and he was taken to the cath lab in fasting state. The patient was prepped and draped in the usual sterile fashion. IV conscious sedation was induced using cath lab protocol. Right groin area was prepped and draped in the usual sterile fashion. It was infiltrated with approximately 10 mL of 1% lidocaine and satisfactory local anesthesia was achieved. Right femoral artery was cannulated using 18 gauge needle and a 5 French arterial sheath was placed. Sheath was flushed. 
A 5 French pigtail catheter was then advanced through the arterial sheath, 
but we had significant difficulty advancing the glide wire. At this time 
angiography was performed via arterial sheath and the right iliac angio was 
performed utilizing digital subtraction angiography. Findings revealed an 
occluded right internal iliac and a tortuous, calcified and diseased right 
external iliac. Under the roadmap then we were able to advance the guide 
wire easily and then we advanced the catheter and subsequently performed 
arch and bilateral carotid angiography, as well as left subclavian artery 
angiography utilizing a JB2 curved catheter. At the end of angiography, 
the catheter was removed, sheath was flushed and findings reviewed. Hand
held pressure was utilized for hemostasis. The patient did well. 
ANGIOGRAPHIC DATA 
RIGHT ILIAC ANGIOGRAPHY: Right iliac angiography revealed a tortuous and 
calcified right iliac. Right internal iliac was occluded. Right external 
iliac had moderate disease and it was patent. 
ARCH AORTOGRAPHY: This revealed normal contour, course and caliber of 
aortic arch. This was a type 1 aortic arch. Right brachiocephalic, lef 
Page 1of 2 
common carotid and left subclavian origins were patent. There appeared to be a high-grade lesion of the left subclavian artery, however. 
Page 2 of2 
SELECTIVE LEFT SUBCLAVIAN ARTERY ANGIOGRAPHY: Left subclavian arteriogram was performed because of the presence of left internal mammary artery graft and it was critical to determine whether the lesion was compromising LIMA flow. Selective catheter placement was done in the left subclavian artery and thereafter the angiogram was taken which revealed a high-grade lesion in the left subclavian distal to the origin of the left internal mammary artery. 
BILATERAL SELECTIVE CAROTID ANGIOGRAPHY: Right carotid angiography revealed a high-grade lesion in the right internal carotid artery in the distal segment. This was a 99.9% stenosis. Right external carotid artery was occluded. 
Left carotid angiography revealed a patent left common carotid and carotid bulb. Left internal carotid artery had moderate 50-60% lesion. Left external carotid was patent. 
CONCLUSIONS: In summary, the patient demonstrates: 

1. Tortuous, calcified and diseased right external iliac with occluded right internal iliac. 

2. Patent origins of right brachiocephalic, left common carotid and left subclavian. 

3. High-grade lesion in the left subclavian distal to the origin of the left internal mammary artery. 

4. High-grade lesion in the right internal carotid of 99% severity. 

5. Moderate disease in the left internal carotid artery of 50-60% severity.


----------



## donnajrichmond (May 24, 2012)

We can partly code this, but unless I'm missing something the doctor does not document where in the carotids he was to do his angiography.  Did he select only to the common carotids, or into the internal carotids?  (just because the imaged the internals does not mean they selected them.)  
The doctor will need to provide an addendum to indicate that.


----------



## dpeoples (May 25, 2012)

karbaker said:


> Page 1 of2
> DATE OF PROCEDURE: 05/17/2012
> NAME OF PROCEDURE:
> 
> ...



here goes:
36215/75710 for left subclavian selection and angio (he actually does document that)
75650 for the arch
75710-59 for the RT lower extremity (iliac, there is good support for medical necessity)
75680 for the cervical (includes common and internal) carotids.
I would not code for cerebral carotids, not enough documentation
I would not code for external carotids, that codes requires selection (catheter placement) which is not documneted.

I agree with Donna, there is probably much revenue being lost because he does not document the catheter end positions very well. 

HTH


----------

