# angiogram



## maryann1224@bellsouth.net (May 29, 2012)

would 36215, 36217, 36216,36215, & 36215 for lt subclavian be correct? thanks for the help...

1. Aortogram
2.  Right innominate angiogram.
3.  Right vertebral angiogram.
4.  Right carotid angiogram.
5.  Left carotid angiogram.
6.  Left subclavian angiogram.

INDICATION::
The patient is a 70-year-old female with left main coronary
disease referred for bypass surgery found to have
moderate-to-severe bilateral carotid arterial disease on
ultrasound.  This was followed up with MRA suggesting severe
bilateral carotid arterial disease, right vertebral arterial
disease, right innominate arterial occlusive disease, left
subclavian arterial occlusive disease.  She is referred for
aortogram and selective angiography for further surgical planning.

PROCEDURE:
After obtaining informed consent, the patient was transported in
the nonsedated condition to the cardiac catheterization suite.  The
patient was prepped and draped in a sterile fashion.  Lidocaine 2%
was used to infiltrate the skin and subcutaneous tissue overlying
the right common femoral artery.  A #5 French introducer sheath
was placed in the right common femoral artery utilizing the
Seldinger technique.  A #5 French pigtail catheter was advanced to
the aortic arch and aortogram was performed and to visualize the
origin of the great vessels.  This was exchanged for a vertebral
catheter that was used to selectively engage the right innominate
artery, the right vertebral artery, the right common carotid
artery.  It was then pulled back and used to selectively engage
the left common carotid artery and the left subclavian artery.
Angiography was performed of these vessels in multiple views.  A
Starclose was deployed in the right common femoral artery at
completion of the procedure with adequate achievement of
hemostasis.

FINDINGS:


HEMODYNAMICS:
Aortic pressure was 154/57.

ARCH AORTOGRAM:
There is diffuse calcified plaquing of the aortic arch.  The
calcification extends up into the innominate artery.  No aneurysm
is noted.

INNOMINATE ARTERY AND RIGHT CAROTID ARTERY:
The innominate artery has a very eccentric calcified plaque at its
origin resulting in a 50% stenosis in the worst view.  The
innominate artery bifurcates into the common carotid artery and
the right subclavian artery.  The right subclavian and proximal
common carotid artery are widely patent.  There is mild
atherosclerotic plaquing at the origin of the right vertebral
artery resulting in 20% stenosis.  The right common carotid artery
appears smooth up into the carotid bifurcation.  There is
calcified plaque at the bifurcation extending into both the
internal and external carotid arteries.  The right external
carotid artery has a 30% stenosis at its origin.  The left
internal carotid artery proximally has an ulcerated plaque
resulting in a shelf-like lesion with a 60% stenosis.

LEFT CAROTID ANGIOGRAM:
The left common carotid artery at its origin is widely patent.
Throughout the length of the left common carotid artery there is
minimal atherosclerotic plaquing.  At the left carotid bulb there
is calcified plaque that extends predominately into the left
internal carotid artery.  The surface of the artery is quite
irregular at this point and eccentric with at least a 60% stenosis
noted and a shelf-like lesion as well.  The left external carotid
artery is patent with no high-grade stenosis noted.  The left
subclavian artery is severely diseased at its origin with at least
a 60% napkin ring lesion.  There is an additional kink in the left
subclavian artery proximal to the left vertebral artery that
results in a eccentric 60% plaque.  The left vertebral artery
appears patent.  The left internal mammary artery is widely
patent.


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## donnajrichmond (May 29, 2012)

maryann1224@bellsouth.net said:


> would 36215, 36217, 36216,36215, & 36215 for lt subclavian be correct? thanks for the help...
> 
> 1. Aortogram
> 2.  Right innominate angiogram.
> ...



Within any vascular family, only one of the "order" catheterization codes can be used - in other words, you can code 36217 OR 36216 OR 36215, but not 2 of them within the same family.  Code to the highest order selected in that family and then additional 2nd or higher branches selected would be coded with the 8 code. 
So, for your case, 36217 for the right vertebral, 36218 for the right common carotid.  There would be no catheterization code for the innominate because the doctor had to go through it to get to the vertebral and the innominate.  Code 36215-59 x 2 for the left carotid and for the left subclavian.  Whether you code -36215-59, 36215-59-59; or 36215-59, 36215-76-59, or some other combination will be payer specific.  
(codes 75650, 75680, 75685, 75710 for the S & I, with possibly 75774 for the innominate.)


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## maryann1224@bellsouth.net (May 29, 2012)

thank you so much for your detailed explanation; i really appreciate it..


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