# Aortogram and bilateral lower extremity runoff angiogram



## Mydream

Very new to this area of the coding world.  The title reflects the procedure.  The following is the operative report.
Would appreciate any guidance in coding this.  I used 36245 and 75716.  The insurance company states this is not correct.

PROCEDURE DETAIL:  After informed consent, the patient was placed supine on the table.  The right wrist was prepped and draped in sterile fashion.  Ultrasound was used to localize the right radial artery.  Flow in both radial ulnar arteries was confirmed prior to puncture.  1% lidocaine was infiltrated for local anesthesia.  Under ultrasound guidance, a micropuncture set was used to access the right radial artery.  A micro wire and micro sheath were advanced.  Through the micro sheath, a 0.035 guidewire was advanced over which a radial access sheath was inserted.  Once radial access was obtained, a 0.035 guidewire was advanced centrally over which a flush catheter was advanced into the ascending aorta.  An upper thoracic aortic arch angiogram was performed.  The catheter was then directed into the abdominal aorta.  Next, pelvic angiogram was performed with obliques.  Next, the left common iliac artery and then external iliac artery was selected with the catheter tip was placed in the external iliac artery on the left.  Left lower extremity runoff was performed.  Next, the right common iliac artery was selected and the catheter was advanced down with the tip placement in the right external iliac artery.  The right leg runoff was then performed.  All wires, catheters, and sheaths were then removed and hemostasis was achieved by placement of TR Band at the puncture site for hemostasis.  The patient was returned to holding in stable condition.

FINDINGS:
The thoracic aortic arch was evaluated, but descending lower thoracic aorta was not evaluated on this study.  The arch itself shows conventional anatomy with no evidence of aneurysm or dissection.
Abdominal aorta is widely patent without evidence of aneurysm or dissection.  Celiac and mesenteric arteries are patent.  The signal renal arteries bilaterally, which are widely patent.



PATIENT: 
PAGE 2

Pelvic angiogram shows widely patent bilateral common iliac and external iliac arteries along with patent hypogastric arteries without evidence of aneurysm or stenosis.
Left leg runoff shows widely patent left common femoral artery, profunda, SFA, and popliteal artery, and patent three-vessel runoff to the left foot.  The plantar arch and dorsalis pedis are widely patent with filling of the digital arteries.
Right leg runoff shows patent right common femoral artery, right profunda, right SFA, right popliteal artery, and three-vessel runoff to the foot with good filling of the plantar and dorsal arches and digital arteries.
It is noted that flow was to and fro and very slow getting down to the feet, although no vascular abnormalities identified.  I suspect there may be some issue with pump or cardiac output due to the very long time it took for the contrast to reach the feet, although normal when it got there.


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## Chlrtrep

I am not sure what the reason is for the Thoracic Arch imaging as it is not mentioned. I would need more information.I do not believe a true pelvic angiogram is being performed I believe this is part of the Bilateral Lower extremity examine.


Additionally if the physician would have mentioned along with is Ultrasound Guidance dictation that there was a "permanent recording" of an image you could also have coded 76937


So  I am thinking

I am not sure about the Thoracic Arch shot but I am leaning toward 36221
Abdominal Aortogram 75625
Bilateral Extremity Angiogram 75716
Selective Cath placement to external iliac Rt, lt   36246, 36246-59/XS


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## j.monday7814

I agree with 36246 billed twice, once for the Right ext iliac and once for the Left ext iliac. I also agree with the 75625 and 75716, but 75774 can also be billed twice since a selective shot was done while the catheter was placed in each ext iliac. I don't agree with the 36221 at all because there aren't any findings of the carotid, vertebral anatomy. I think the ascending aortography was done to visualize the celiac, mesenteric, and renals which would be a part of 75625.


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## lcaskew1

Jeremy, why would you report 75774 twice in addition to 75716? Doesn't 75716 cover the bilateral angiography of the extremities?


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