# Abdominal Aortogram w/ runoff



## 634sg4fs65g4fg

Can anyone confirm for me cath access and what to bill for the access? I am getting better and peripheral coding but still struggling. For some reason the office I am in has never used some cath entrance codes that I see from reports should clearly be used. Here is the report and I believe I should code 36200 for cath entrance, 75625 for abdominal runoff. Do you agree or am I missing anything? I also feel my reports are not completed in full sometimes making it very hard to code properly. Thank you in advance for your help! 

PREPROCEDURE DIAGNOSIS
POSTPROCEDURE DIAGNOSIS
PROCEDURE PERFORMED
Aortogram with bilateral runoff.
HISTORY
The patient had a recent lower extremity ultrasound, which disclosed 80% right
common femoral artery stenosis brought in today for aortogram with bilateral
runoff.
EQUIPMENT USED
4-French Universal catheter, 4-French sheath, 0.035 Glidewire
ANESTHESIA
Versed and fentanyl for conscious sedation.
COMPLICATIONS
None.
PROCEDURE
Under sterile technique the left femoral site was prepped and draped. 1%
lidocaine was used for local anesthesia. Modified Seldinger approach used for
arterial cannulation and over-the-wire technique was used for all sheath and
catheter exchanges.
FINDINGS
Abdominal aortogram demonstrated normal contour to the abdomen with normal
bilateral renal arteries. No evidence of atherosclerosis or aneurysm,
bilateral common iliac arteries were angiographically normal in appearance.
They gave rise to an external and internal branch bilaterally, which were
angiographically normal in appearance. Selective views of the left lower
extremity showed angiographically normal. Common femoral artery, bifurcating
into an angiographically normal profunda femoris, and superficial femoral
artery. Popliteal and 3-vessel runoff were normal on the left. Selective views
of the right lower extremity demonstrated normal appearance of the common
femoral artery with no evidence of atherosclerosis or narrowing. It gave rise
to a profunda and superficial femoral artery that were angiographically normal
in appearance. The popliteal was angiographically normal in appearance and
there was 3-vessel runoff noted to the foot. After final pictures, the sheath
was removed and manual pressure was applied for hemostasis. The patient was
felt stable for discharge home after discharge criteria met.
IMPRESSION
Normal aortogram with bilateral runoff and hyperlipidemia.


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## dpeoples

thomasgail said:


> Can anyone confirm for me cath access and what to bill for the access? I am getting better and peripheral coding but still struggling. For some reason the office I am in has never used some cath entrance codes that I see from reports should clearly be used. Here is the report and I believe I should code 36200 for cath entrance, 75625 for abdominal runoff. Do you agree or am I missing anything? I also feel my reports are not completed in full sometimes making it very hard to code properly. Thank you in advance for your help!
> 
> PREPROCEDURE DIAGNOSIS
> POSTPROCEDURE DIAGNOSIS
> PROCEDURE PERFORMED
> Aortogram with bilateral runoff.
> HISTORY
> The patient had a recent lower extremity ultrasound, which disclosed 80% right
> common femoral artery stenosis brought in today for aortogram with bilateral
> runoff.
> EQUIPMENT USED
> 4-French Universal catheter, 4-French sheath, 0.035 Glidewire
> ANESTHESIA
> Versed and fentanyl for conscious sedation.
> COMPLICATIONS
> None.
> PROCEDURE
> Under sterile technique the left femoral site was prepped and draped. 1%
> lidocaine was used for local anesthesia. Modified Seldinger approach used for
> arterial cannulation and over-the-wire technique was used for all sheath and
> catheter exchanges.
> FINDINGS
> Abdominal aortogram demonstrated normal contour to the abdomen with normal
> bilateral renal arteries. No evidence of atherosclerosis or aneurysm,
> bilateral common iliac arteries were angiographically normal in appearance.
> They gave rise to an external and internal branch bilaterally, which were
> angiographically normal in appearance. Selective views of the left lower
> extremity showed angiographically normal. Common femoral artery, bifurcating
> into an angiographically normal profunda femoris, and superficial femoral
> artery. Popliteal and 3-vessel runoff were normal on the left. Selective views
> of the right lower extremity demonstrated normal appearance of the common
> femoral artery with no evidence of atherosclerosis or narrowing. It gave rise
> to a profunda and superficial femoral artery that were angiographically normal
> in appearance. The popliteal was angiographically normal in appearance and
> there was 3-vessel runoff noted to the foot. After final pictures, the sheath
> was removed and manual pressure was applied for hemostasis. The patient was
> felt stable for discharge home after discharge criteria met.
> IMPRESSION
> Normal aortogram with bilateral runoff and hyperlipidemia.



I see 75630 for the aorta and bilateral extremites but catheter placement/movement is not documented.

HTH


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## 634sg4fs65g4fg

Wouldn't this part of the report be the cath entrance? It states left femoral site prepped and drained for cath exchanges: 
Under sterile technique the left femoral site was prepped and draped. 1%
lidocaine was used for local anesthesia. Modified Seldinger approach used for
arterial cannulation and over-the-wire technique was used for all sheath and
catheter exchanges.


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## donnajrichmond

I agree.  The report isn't documented sufficiently for coding.  
"Wouldn't this part of the report be the cath entrance? It states left femoral site prepped and drained for cath exchanges: 
Under sterile technique the left femoral site was prepped and draped. 1%
lidocaine was used for local anesthesia. Modified Seldinger approach used for
arterial cannulation and over-the-wire technique was used for all sheath and
catheter exchanges." 
He started in the left femoral - but this does not tell us where he went.  He says later that he did selective imaging of the extremities but doesn't tell us where his catheter was at when he did that.   "Selective views of the left lower extremity showed ... Selective views
of the right lower extremity demonstrated ..."
Did he do a true abdominal aortogram with run-off - catheter placed high in the aorta with injection of contrast and imaging of the aorta and the extremities with no maneuvering of the catheter?  Or did he do an abdominal aortogram with bilateral extremity angiograms- catheter placed high in the aorta with imaging of the aorta and then repositioning of the catheter either to the bifurcaton or into the iliacs?  Did he then further select to femorals?


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## theresa.dix@tennova.com

donnajrichmond said:


> I agree.  The report isn't documented sufficiently for coding.
> "Wouldn't this part of the report be the cath entrance? It states left femoral site prepped and drained for cath exchanges:
> Under sterile technique the left femoral site was prepped and draped. 1%
> lidocaine was used for local anesthesia. Modified Seldinger approach used for
> arterial cannulation and over-the-wire technique was used for all sheath and
> catheter exchanges."
> He started in the left femoral - but this does not tell us where he went.  He says later that he did selective imaging of the extremities but doesn't tell us where his catheter was at when he did that.   "Selective views of the left lower extremity showed ... Selective views
> of the right lower extremity demonstrated ..."
> Did he do a true abdominal aortogram with run-off - catheter placed high in the aorta with injection of contrast and imaging of the aorta and the extremities with no maneuvering of the catheter?  Or did he do an abdominal aortogram with bilateral extremity angiograms- catheter placed high in the aorta with imaging of the aorta and then repositioning of the catheter either to the bifurcaton or into the iliacs?  Did he then further select to femorals?




I agree with donnajrichmond. This is a good example of why you cannot use the word "selective" to code a cath placement .He says at top procedure performed "aortogram with bi/run off" and then in the body of the note he says selective views of the left lower extremity showed angio normal, run off isn't a selective view. If he actually did selective angio of the lower extremity and placed a cath it would be more then a aortogram. ( which is what he calls the procedure). I think you should ask for an addendum.


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