# Cerebral Angiogram



## todd5400 (Mar 10, 2009)

Need help!! How would you code the following

1.  Right transderm cerebral angiogram selective. RCC artery, cervical view
2.  Selective RCC artery, intracranial view.
3.  Selective LCC artery, cervical view.
4.  Selective LCC artery, intracranial view.
5.  Selective right subclavian artery, cervical view
6.  Selective right vertebral artery, intracranial view
7.  Superselective catherization GDC embolization, right PICA aneurysm
8.  Control angiography selective right vertebral artery intracranial views 
     times 4 runs.

Thank you in advance
Mary


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## MLS2 (Mar 10, 2009)

would you be able to provide a complete report (access site, anatomy, etc...)


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## todd5400 (Mar 11, 2009)

The right common femoral artery ws accessed and dilated with a sheath. Catheter was navigated into the RCC with DS angiography.  Catheter was removed and navigated into LCC with DS angiography performed.  The catheter was removed and attempts made to navigate into the LShowever I suspect it was occluded.  Catheter navigated into the RS with DS angiography. Vetebral artery selectively catherized with DS angiography performed.  

Thanks a bunch for helping me!!
Mary


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## MLS2 (Mar 12, 2009)

there was mention of a superselection and embo done in your first post but I don't see it mentioned in the piece of report on the 2nd post...


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## Jim Pawloski (Mar 12, 2009)

*cerebral angiogram*

Going by what I have seen in the post, I would go with this:
36217 - rt vertebral
36218 - rt common carotid
36215 - lt common carotid
75671-59 - Carotid cervical bilateral
75680-59 - common cerebral bilateral
75685-59 - Unilateral vertebral
61624 - Embolization CNS permanent
75894 - embo. s&i
75898 x 4 - post embo. imaging


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## MLS2 (Mar 12, 2009)

36217 51 Rt vertebral/PICA
36218 Rt common
36215-59 51  left common
75671  bilateral internals
75680  bilateral commons
75685 RT vertebral
75894 intracranial embo
61624
75898 post-embo follow-up (total # could vary...I'm not sure that I would bill "4 runs" through the same artery as follow-ups.  If the embo was done and the "runs" were done on the way out of the artery to check the status of the embo, I would just do that as one follow-up post embo.  make sense?)

Also, if the right PICA was superselectively cath'd, you could add 75774 for that selection.


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## todd5400 (Mar 12, 2009)

I did not include the embo because I know how to code that part.  Sorry! The actual part I was questioning were the 36XXX codes of which I had picked the same codes as you - so I guess I am learning.  Again thank you so much for all the support and I apologize for making it confusing.
Mary


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## MLS2 (Mar 12, 2009)

gotcha, no problem.  I just wanted to make sure that I had all the info.

thanks!


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## Jim Pawloski (Mar 12, 2009)

*Cerebral Angio*

I just went to a seminar where the presenter stated that you can code for the number of post embo. imaging that are dictated only in the brain, since it is a "delicate organ".  That is why I wrote 75898 x 4.  It can only be used once everywhere else.


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## Mouf1818 (Mar 12, 2009)

I completely agree with Jim, I've coded these forever and the interventional radiology coder by medlearn tells you that if the follow-ups are in the brain or spine (even if same artery) you may charge per follow-up.  If it's in any other part of body, you would only charge it once.  So I would code the 75898 x4 in this case and I agree with all the rest of Jim's codes!

Amber, CPC


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## MLS2 (Mar 18, 2009)

interesting...I really haven't seen it worded like that before.  Per the 2009 Interventional Radiology Coder pg. 13 note# 5

"Code 75898 is submitted only once when extracranial embolization or infusion therapy is performed, regardless of the number of separate vessels treated and subsequently injected."


 I have however also coded for more than one 75898 on some cases if the documentation supported it.


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