# Iliofemoral angio confusion



## Robbin109 (Jun 29, 2012)

I know any angio's done to access the closure site is inclusive to the heart cath, but what about when just a iliofemoral is done  with no mention of the closure site. I looked into some notes I have:

From Dr. Z's Webiner July, 2011 "angiography for closure device placement and the actual closure device placement are inclusive" 

From Dr. Z's Diagnostic and Intervention Cardiovascular coding Reference:
"If non-selective ileofemoral angiography is performed at the time of a cardiac catheterization either form the sheath or a catheter in the abdominal aorta, use G0278"

So my question is, does this procedure constitute use of G0278? ( Just need help with Iliofemoral angio, no the whole report. Thanks!   


TITLE:  Left heart catheterization, left ventriculogram via selective         

injection, selective coronary arteriography, left and right.  Iliofemoral     

angiography, right and Angio-Seal closure.                                    



TECHNIQUE:  Following preparation of the right groin, the right femoral artery

was entered.  A 6-French sheath placed, 6-French pigtail catheter was placed  

in the left ventricle via retrograde fashion and left ventriculography        

performed in the RAO and LAO projections.  Catheter was exchanged for an R4   

catheter, 6-French and right coronary arteriography performed.  Catheter was  

exchanged for a left 4 Judkins catheter.  Left coronary arteriography         

performed in multiple projections and iliofemoral angiography was performed   

via the sheath.  There was no immediate complication.                         



FINDINGS:                                                                     

Hemodynamics:  Left ventricular end-diastolic pressure was 22.  There was no  

systolic gradient across the aortic valve.                                    



Angiography:  Left ventriculography regional wall motion shows the inferior   

wall to be normally.  The proximal anterior wall is hypokinetic.  The distal  

anterior wall is severely hypokinetic and the inferoapical a localized segment

is dyskinetic on the LAO projection, the posterior wall is normal and the     

septum is hypokinetic.  Overall, left ventricular ejection fraction estimated 

at 40-45%.                                                                    



The right coronary artery is stented from the ostium to the mid vessel.  The  

right coronary artery shows an ostial greater than 80% stenosis and then there

is diffuse in-stent restenosis throughout much of the length of the stented   

portion of the vessel.  After the large first marginal branch the vessel is   

totally occluded in stented area.  There is distal filling of the artery via  

left-to-right collateral blood flow.                                          



The left main coronary has no high-grade stenosis.  The left anterior         

descending in its stented portion shows no high-grade stenosis.  There is a   

subtotal occlusion of the origin of the second and third diagonals, which was 

seen on previous angiography.                                                 



There has been progressive disease in the proximal segment of the obtuse      

marginal branch with now eccentric 80% stenosis involving the main branch and 

then a subtotal stenosis involving the ostium of the upper branch of this     

marginal (bifurcation lesion).                                                


Impression of the right iliofemoral angiogram shows no significant stenosis in

the iliac or femoral artery. 

IMPRESSION:                                                                   
1.  Prior apical myocardial infarction with reduced left ventricular ejection 
fraction to 40-45%.                                                           
2.  Mildly elevated left ventricular end-diastolic pressure.                  
3.  Multivessel coronary artery disease with interval occlusion of the right  
coronary artery with additional diffuse in-stent restenosis.                  
4.  No in-stent restenosis in the left anterior descending.                   
5.  Progressive disease in the circumflex marginal.


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## Jim Pawloski (Jun 29, 2012)

Robbin109 said:


> I know any angio's done to access the closure site is inclusive to the heart cath, but what about when just a iliofemoral is done  with no mention of the closure site. I looked into some notes I have:
> 
> From Dr. Z's Webiner July, 2011 "angiography for closure device placement and the actual closure device placement are inclusive"
> 
> ...



In the title, the doctor states "Angio-seal closure", so I would not code for the rt iliofemoral angio.
HTH, 
Jim Pawloski, CIRCC


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## Robbin109 (Jun 29, 2012)

Thanks, Jim, When would be a correct time to code a G0278 for this procedure? 

Thanks!!!


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## jsccollins (Jul 9, 2012)

There needs to be a clearly documented indication for the ilio-femoral study (other than closure device placement) in order to report it.  You will occasionally see doctors document difficulty advancing the catheter through the iliac artery (suggesting that there is occlusion of some sort) and this is followed by a diagnostic study of the vasculature.  In most cases where a closure device is used you should not be reporting G0278.  It is a pretty low paying service and it frequently triggers a manual review (i.e. audit) of the note.

Jim Collins, CPC, CCC
President, CardiologyBiller.Com


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