Cardiology Coding Alert
Ascending Aortogram on a Bovine-Arch Patient
New York subscriber
Answer: You should report 36217 (Selective catheter placement, arterial system; initial third-order or more selective thoracic or brachiocephalic branch, within a vascular family) for the catheter placement. Typically catheterization of the right common carotid artery is a second-order catheter position. In this case, however, the patient has a bovine arch (as indicated in the report excerpt), which makes this a third-order catheter position.
A bovine arch is an anatomic anomaly found in roughly 30 percent of the population. With this anomaly, the left common carotid artery takes off from the innominate artery rather than from the aorta. The ostium (opening) of the left common carotid artery, therefore, is in the same vascular family as the right common carotid artery. To reach the right common carotid artery, the cardiologist must first leave the aorta and enter the innominate artery (becoming first order), pass the ostium of the left common carotid artery (becoming second order) and then selectively engage the right common carotid artery (becoming third-order selective).
You can also code for the imaging of the right common carotid artery (75676, Angiography, carotid, cervical, unilateral, radiological supervision and interpretation) and the right internal carotid artery (75665, Angiography, carotid, cerebral, unilateral, radiological supervision and interpretation).
The only modifier necessary on this claim form is 26 (Professional component), which you should attach to the radiological supervision and interpretation codes (75676 and 75665).
Caution: You probably shouldn't report 75650 (Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation) for the ascending aortogram because the information in the op note sounds more like a guiding short than a diagnostic study of the aortic arch. You should use the radiological supervision and interpretation codes to report diagnostic studies.
Trap: The information provided does not illustrate the medical necessity for an arch study, nor do you list what the cardiologist's findings are. If you can't find this in your cardiologist's note, you should apply the old adage "not documented, not done." Because the cardiologist does not provide any diagnostic findings of the aortic root/arch study, you should not report it.
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