# Peripheral question



## rykin7609 (Mar 2, 2012)

Most times the access point for a peripheral is the femoral artery. How is it coded when the access point is the politeal?
Not only that but say the right popliteal is accessed and the physician takes the cath up and around to the left going to the left SFA, what is the cath placement order when this occurs?

Any thoughts would be greatly appreciated!


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## jmcpolin (Mar 2, 2012)

Left popliteal puncture and catheter is moved up to the SFA it is first order 36245


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## rykin7609 (Mar 8, 2012)

But if the RIGHT popliteal is the access point and the cath selectivley engages the LEFT SFA how can that be the first order?


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## jmcpolin (Mar 8, 2012)

because if you punctured the popliteal and just stayed there it would be 36140, but since you are puncturing the pop and moving the cath up to the sfa it would be 36245


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## rykin7609 (Mar 8, 2012)

sorry but I am not sure you understood the question.....then again maybe I didn't clarify. 

The cath moved from the right (leg) to the left (leg). That cannot possibly the first order only. Because the cath moved from the right popliteal, through the right sfa, the right common femoral, the right common iliac, over the bifurication, into the left common iliac, down the left common femoral and into the left sfa. 

Does that help? as you can see it is far more than the first order.....


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## dpeoples (Mar 8, 2012)

rykin7600 said:


> sorry but I am not sure you understood the question.....then again maybe I didn't clarify.
> 
> The cath moved from the right (leg) to the left (leg). That cannot possibly the first order only. Because the cath moved from the right popliteal, through the right sfa, the right common femoral, the right common iliac, over the bifurication, into the left common iliac, down the left common femoral and into the left sfa.
> 
> Does that help? as you can see it is far more than the first order.....





A contralateral (opposite side) selection of the SFA would be a third order (36247) selection, whether access is the popliteal, femoral or iliac. 

The catheter is moved from the access site through subsequent vessels, up and over (through) the aortic bifurcation into the vessels of the opposite leg. 

If the popliteal is the access site, the ipsilateral (same side) femoral artery would be first order, the ipsilateral iliac artery would be second order. The aorta is still non-selective (36200... even though that seems illlogical), and any contralateral artery is third order.

HTH


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## hbailey42 (Mar 8, 2012)

Just wondering if you are using the new peripheral codes? Since you show stenting of the right common iliac you would not use cath placement codes because it is included in the new peripheral codes. I would use 37211 for the iliac stent, 75716-26-59 for bilateral angiography, and 37204 & 75894 for the coiling/SI. But I am just going off what you listed.

Good Luck,
Heather, CPC, CCC


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## hbailey42 (Mar 8, 2012)

You can also bill the IVUS 37250/75945-26 for 1st vessel and 37251/75946-26 for each additional vessel.


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## donnajrichmond (Mar 8, 2012)

hbailey42 said:


> Just wondering if you are using the new peripheral codes? Since you show stenting of the right common iliac you would not use cath placement codes because it is included in the new peripheral codes. I would use 37211 for the iliac stent, 75716-26-59 for bilateral angiography, and 37204 & 75894 for the coiling/SI. But I am just going off what you listed.
> 
> Good Luck,
> Heather, CPC, CCC



There are actually 2 separate coding questions going on here and getting confused. 
rykin7600 asked about popliteal to contralateral SFA catheterization.  No interventions were mentioned.  
Then, instead of opening a new thread, rparikh asked how to code several procedures.  
So, when responding, please note which one you are responding to!

Now, as for the 1st question - popliteal to contralateral SFA - I agree that the catheterization would be 36247 - but I disagree with the following statement "If the popliteal is the access site, the ipsilateral (same side) femoral artery would be first order, the ipsilateral iliac artery would be second order. The aorta is still non-selective (36200... even though that seems illlogical), and *any contralateral artery is third order*.".  In my opinion, all on the ipsilateral side would be non-selective 36140.  Once you hit the bifurcation and go into the other extremity, you are in a new vascular family, so common iliac would be 1st order (36245), external and internal iliacs and common femoral would be 2nd order (36246), and SFA and profunda would be 3rd order (36247).


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## donnajrichmond (Mar 8, 2012)

rparikh said:


> I need help with coding on following Procedures:
> 
> 1) Carbon dioxide angiography of the left iliac artery
> 2) Carbon dioxide angiogram of the right iliac artery and right internal iliac artery.
> ...



You can't code just from a list of procedures.  Where did they start? were the angiograms diagnostic or roadmapping? was this stenosis or aneurysm treatment?


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## theresa.dix@tennova.com (Mar 9, 2012)

donnajrichmond said:


> There are actually 2 separate coding questions going on here and getting confused.
> rykin7600 asked about popliteal to contralateral SFA catheterization.  No interventions were mentioned.
> Then, instead of opening a new thread, rparikh asked how to code several procedures.
> So, when responding, please note which one you are responding to!
> ...



I agree with Donna, she is absolutely right!


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## dpeoples (Mar 9, 2012)

Sorry for the confusion. I don't think I am making things up, I must have learned or read what I posted somewhere, though I am having difficulty finding suportive documentation. 

Donna, and Teresa, I woud be very interested in any reference on the subject either of you may have.


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## Jim Pawloski (Mar 12, 2012)

dpeoples said:


> Sorry for the confusion. I don't think I am making things up, I must have learned or read what I posted somewhere, though I am having difficulty finding suportive documentation.
> 
> Donna, and Teresa, I woud be very interested in any reference on the subject either of you may have.



Danny,
Are you as totally confused as I am on this thread?  I think we have two different subjects on the same thread.  Someone wanted an answer to their question but didn't want to start a new thread.  I agree, the people who started the questions did not  give full inforfmation to be able the question properly.
Jim Pawloski, R.T. (CV), CIRCC


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## theresa.dix@tennova.com (Mar 15, 2012)

Jim and Danny,
 Yes i think this thread got messed up.


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