# Ascending Aortogram/4 vessel arch Coding Help



## AshleyMartin (Oct 31, 2011)

Please help me code this:

Procedures:
1. Ascending aortogram/four-vessel arch 
2. Selective carotid/cerebral angiogram

Access was obtained via the right femoral artery via modfified Seldinger technique after 1% lidocaine was used to anesthetize the area. A 6-French sheath was placed in right femoral artery, flushed without any complications. We introduced a pigtail catheter over 0.35 J-wire. This was used to perform the ascending aortogram with four-vessel arch.

We then selected a 4-French Bernstein II diagnostic catheter. This was used to selectively engage the right common carotid artery using just a regular J-wire. Images using biplane cine angiography under digital subtraction were performed. There was a bovine arch noted. We were able to select the left carotid using angled Glidewire. Angiographic pictures were subsequently taken. Selective angiographic shot of the right femoral access site was taken and a 6-French Mynx was deployed to obtain hemostasis. The patient tolerated the procedure well. There were no complications. 

Findings:
1. The ascending aorta and arch are free of aneurysm or dissection. There is a bovine arch noted. 
2. The right internal/external carotid arteries are patent. There is no residual evidence of dissection. This fills the MCA and the ACA on the right. 
3. The left internal common and ECA are patent. It fills the MCA and ACA on the left. 

This is what I have:

36215-lt
36216-rt
75671
75680


----------



## dpeoples (Oct 31, 2011)

AshleyMartin said:


> Please help me code this:
> 
> Procedures:
> 1. Ascending aortogram/four-vessel arch
> ...




I would code this:
36217 RT
36218 LT (same vascular family due to Bovine Arch)
75650-26
75680-26
75671-26

HTH


----------



## donnajrichmond (Nov 1, 2011)

I mostly agree with Danny, but there is something to think about.  There are really 2 types of "Bovine" arch.   What most people think of, and what SIR shows in their guide is where the left common carotid arises from up on the innominate artery.  In that case, the codes as Danny listed them are correct.  
However, a 2nd type of bovine arch is where the innominate and left common carotid have a common origin.  In that case, we recommend that the left common not be coded as part of the same family as the innominate but it's own family with the "regular" coding of 36215 for the left common and 36216 for the right common.  
This article has pictures of the 2 variants, though it doesn't address the coding:  http://www.ajnr.org/content/27/7/1541.full


----------

