# Bilateral Carotid Arteriogram



## amym (Jan 27, 2012)

Please help with coding!

Procedure Performed: 
1. Thoracic aortic arch aortogram. 
2. Bilateral selective carotid arteriogram. 
3. Intracranial angiography. 

Indication:  Mr. Salmon presented with symptoms of dizziness without 
known coronary artery disease with history of stents and noninvasive 
imaging revealed high-grade stenosis of the left carotid artery with 
CT angiography.  However the degree of stenosis was not certain on 
the CT angiography. 

Protocol:  The patient was brought to the cath laboratory.  Right 
groin was prepped and draped in the usual sterile fashion. 
Xylocaine was infiltrated.  A 5-French sheath was inserted without 
difficulty and subsequently a 5-French pigtail catheter was advanced 
and positioned in the ascending aorta.  Thoracic aortogram was 
performed subsequent to which the catheter is removed and then a 
Headhunter catheter was advanced.  The right brachiocephalic artery 
was cannulated however the catheter was selected into the 
brachiocephalic artery but could not be advanced into the right 
carotid artery.  The left carotid artery was cannulated selectively. 
In both locations carotid as well as intracranial angiography was 
performed.  Total contrast used was 160 mL.  No complications 
occurred.  The sheath was removed after the procedure was completed. 

Findings:  The aortogram revealed presence of normal-appearing 
ascending arch and descending aorta with normal takeoff of the great 
vessels.  This appears to be a type 1 arch and the Headhunter 
catheter was placed selectively in the right brachiocephalic artery. 
The origin of the artery appears to be normal.  The takeoff of the 
carotid artery, common carotid artery, and the bulb area all 
appeared to be normal.  There is only mild, less than 20% plaque 
noted and the external carotid artery is intact.  The extracranial 
portion of the carotid artery appears to be normal as well. 

The right-sided intracranial circulation has less than optimal 
visualization however appears to be intact with no definite lesions 
identified.  However there was some motion artifact as well as 
suboptimal filling of the vessel and therefore may result in 
accurately compromised. 

The left carotid artery appears to show normal common carotid 
artery, and the takeoff is preserved.   The external carotid artery 
is without any significant disease. 

Internal carotid artery on the left side demonstrates an apple-core 
lesion which appears to be at least 70 to 80% in severity.  The 
distal portion of the internal carotid artery as well as the 
extracranial course appears to be without any significant disease. 

The left intracranial angiography is selective and with good 
excellent images and appears to have normal-appearing vessels 
throughout the middle and anterior cerebral arteries with normal 
venous phase. 

Impression: 

1. The left internal carotid artery with 70 to 80% stenosis. 
2. The right intracranial visualization was suboptimal. 
3. Mild plaque on the right internal carotid artery.


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## donnajrichmond (Jan 27, 2012)

36215 (right brachiocephalic catheterization) 
36215-59 (left common carotid catheterization 
75650 - arch
75671 - bilateral cerebral carotid angiography
75680 - bilateral cervical carotid angiography


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## dimmitta (Jan 27, 2012)

Donna has it right, that is the way I would code this too


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## dpeoples (Jan 27, 2012)

donnajrichmond said:


> 36215 (right brachiocephalic catheterization)
> 36215-59 (left common carotid catheterization
> 75650 - arch
> 75671 - bilateral cerebral carotid angiography
> 75680 - bilateral cervical carotid angiography



I agree with these codes.
HTH


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## amym (Jan 27, 2012)

Thanks all


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