# Abdominal Aortogram (75625-26) - need ICD-10 code



## JS81coder (Mar 18, 2018)

What would be an appropriate diagnosis code for the abdominal aortogram (75625-26) done here? I'm not seeing anything documented that is on the LCD for the medical necessity. I could use some help with this.

Study Result 

DATE OF PROCEDURE:                         03/08/2018  
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INDICATION FOR STUDY:                     NON-STEMI   
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PROCEDURE PERFORMED:                           LEFT HEART CATHETERIZATION 
                                                                      ABDOMINAL AORTOGRAM 
                                                                      VASCULAR ULTRASOUND OF THE LEFT MAIN 
                                                                      PCI OF THE LEFT MAIN WITH DRUG ELUTING STENT 
                                                                      PCI OF THE DIAGONAL ARTERY WITH A DRUG ELUTING STENT 
**
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CLINICAL SUMMARY:            An 81-year-old male with past medical history significant for diabetes mellitus, hypertension, smoking, chronic kidney disease and bladder cancer who was recently admitted to Hospital with non-ST elevation myocardial infarction. *Diagnostic cardiac catheterization revealed severe left main disease. *The patient was transferred to Medical Center for further evaluation and management. *Based on patient's clinical comorbidities, ST score, severe LV systolic dysfunction, cognitive impairment/dementia the heart team and patient's family and patient decided to proceed with percutaneous revascularization. *Informed consent obtained.
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PROCEDURE: *                     The patient was brought to the cath lab in stable condition. *Informed consent was provided after all risks and benefits were explained. *The patient was draped and prepped in usual fashion. 1% lidocaine was administered for local anesthesia.  The femoral artery was accessed using micropuncture kit and a 7-French sheath was inserted in the left femoral artery. A*5 Fr sheath was placed in femoral vein. EBU 3.5 catheter was used to perform left coronary artery angiography. * A pigtail catheter was used to performed LV hemodynamics.**The pigtail catheter was also used to perform abdominal aortogram.  Femoral angiogram was performed which revealed sheath was suitable for vascular device.  Angioseal *vascular closure device was used for arterial hemostasis. *
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FINDINGS:
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Aortic pressure 120/80 mmHg. *
Left ventricular end-diastolic pressure was 14 mmHg. *
There was no significant gradient between left ventricle and aorta.
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CORONARY CINE ANGIOGRAPHY:        Coronary circulation is right dominant.
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ABDOMINAL AORTOGRAM:        *There is no significant disease in bilateral iliac and femoral arteries.
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LEFT MAIN CORONARY ARTERY:            The left main coronary artery has critical calcified/ulcerated 95% to stenosis.
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LEFT ANTERIOR DESCENDING CORONARY ARTERY:      Ostial/Proximal 50-70% stenosis. The left anterior descending coronary artery gives off a large diagonal artery. *The diagonal artery has proximal 90% stenosis. *The LAD itself continues as a small to medium caliber vessel with diffuse 40% disease.
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PCI DETAILS:                   A 7-French, EBU3.5 guide catheter was used to intubate the left main.  A short Runthrough wire was used to cross the lesion placed distally into diagonal artery. *A BMW wire was also placed into left circumflex artery. *Predilation of left main lesion was performed with 3.0 noncompliant balloon. *This is followed by deployment of a drug-eluting stent Synergy 2.5 x 24 mm in diagonal 1. *Stent was post dilated with stent balloon. *This is followed by deployment of a drug-eluting stent Synergy 3.5 x 20 mm extending from left main into left anterior descending artery. *This stent was post dilated with 3.5 and 4.0 noncompliant balloon. *Intravascular ultrasound was used for stent size and length. *Intravascular ultrasound revealed well expanded and well opposed stent. *There was no significant plaque shift towards left circumflex artery. *There was no significant stenosis there was no dissection and there was no perforation.*
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IMPRESSION: 
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1.  Severe left main disease which was treated with single drug-eluting stent  (provisional stent technique) under intravascular ultrasound guidance.
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2.  Severe diagonal disease which was treated with single drug-eluting stent.*
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RECOMMENDATIONS: *
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1.  Dual antiplatelet therapy. 
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2.  Aggressive medical therapy and risk factor modification.

____________________________________
 PAST MEDICAL HISTORY
He has a past medical history of Anxiety; Bladder cancer; Chronic kidney disease (CKD), stage III (moderate); Depression; Diabetes; Hyperlipidemia; Hypertension; Nephrolithiasis; Prostate cancer; Restless leg; and SVT (supraventricular tachycardia). He has a past surgical history that includes hx hernia repair (Bilateral); hx knee replacement (Right); and tonsillectomy.


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## Jim Pawloski (Mar 19, 2018)

JS81coder said:


> What would be an appropriate diagnosis code for the abdominal aortogram (75625-26) done here? I'm not seeing anything documented that is on the LCD for the medical necessity. I could use some help with this.
> 
> Study Result
> 
> ...




I would not code for 75625 as the renal arteries and the actual abdominal aorta. At the most, you could say that the aortogram was for vascular closure device which is not billable for a heart cath.
HTH,
Jim Pawloski CIRCC, R.T. (CV)


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