# Cath w/angiography



## JayRitten (Jan 17, 2014)

I need a little help please.
Procedure as dictated:

Right heat cath performed.
Left heart cath with selective coronary angiography performed.
Left ventricular angiography performed. 
Selective saphenous vein graft.
Selective left subclavian artery angiography.  
Selective right subclavian artery angiography performed.
Thoracic aortography performed.
Abdominal aortography with runoff to the feet.

Sequence:
1.  Sheath placed in right femoral artery, right heart cath performed.
2.  Left heart cath, selective cors performed. Left ventricular angiography performed.  Selective saphenous vein graft angiography performed.  Selective left subclavian artery angiography performed.
3.  Selective right subclavian artery angiography performed. Using the pigtail catheter, thoracic aortography was performed.
4.  Using pigtail catheter, abdominal aortography with runoff to the feet was performed.

Diagnostic findings:
1. Left ventricular function normal, no aortic gradient on pullback, left main is normal, LAD is occluded proximally, circumflex is normal, obtuse marginals normal, right coronary 70% stenosis.  Right heart pressures are given.
2. Saphenous vein graft to diagonal patent, with visualization retrogradely feeds the LIMA all the way back with retrograde feed of the left subclavian as well.
3. Saphenous vein graft to another saphenous vein graft occluded.
4. Right innominate artery is normal, right common carotid patent. Right subclavian is patent, with right to left filling using subclavian steal physiology to the left vertebral artery, retrogradely fills the left subclavian and left internal mammary artery.
5. Left carotid is patent
6. Left subclavian artery is completely occluded at its ostium.
7. Thoracic aortography revealed no other bypass grafts and thoracic aorta is normal, no aneurysm.
8. Abdominal aortography reveals the renal arteries patent.  Distal abdominal aorta has atherosclerotic ulceration, but no gradient and to significant stenosis or aneurysm.
9. Bilateral common iliacs with previous stent ar widely patent, bilateral internal iliacs, external iliacs, common femorals are patent.  Bilateral SFA and profunda vessels are patent no significant disease. Bilater popliteals are patent, bilateral posterior tibial artery, peroneal vessels are patent, left antecubital not well seen, also endothelial dysfunction flow to the feet.

93461-26
75605-26-59
75716-26-59
36215
75710-26-59
Is this correct?


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## jewlz0879 (Jan 21, 2014)

For the selective Subclavian cath placement with angio, I would go with 36225. 

It's hard to be certain without the actual report with cath placement(s), however, I would go with 75630-26-59 for the aortogram _with_ run-off. 

You wouldn't capture 75710 & 75716 because 75716 IS the bilateral procedure. 

HTH


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## JayRitten (Jan 26, 2014)

Thanks for your help


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## TerryFletcherCPC (Jan 31, 2014)

*Cath w/angio*

Based on your report, and lack of specific details of cath placements, only angio data, here is what you can support:
93461.26 (this include the graft injection where the cath is placed in the subclavian-not a separate service)
75630.26 (Abd aortogram including lower extremity runoffs)
75605.26 Thoracic aortogram (this is rarely done by a Cardiologist)
36221.59 Based on angiographic data it looks like an arch injection was done to look at the carotids. This is a non-selective service. 

There is no evidence of a selective subclavian, only the header lists it. Not enough. You would need report detail and indications showing why and how the cath was manipulated into these vessels. So from the report 4 codes


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## JayRitten (Feb 5, 2014)

Thanks Terry, I did add the sequence to the procedure, if you've time to take another look, I'd really appreciate it.
Jay


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