You Be the Coder:
Leg Catheter for Vessel Examination
Published on Tue Jan 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Two coders in our office disagree about the proper codes to assign to the following report. One recommends reporting CPT 36245 (twice) and 75710-LT, while the other says to use 36200 with CPT 75625 and CPT 75716 . Which of these is correct?
Case: A catheter was placed in the left femoral artery and advanced into the aorta at the level of the renal arteries. Then 15 cc contrast material was injected. There were single renal arteries to both kidneys. They were widely patent without evidence of disease. There appears to be an aortoiliac bypass bilaterally. On the right, the limb of the prosthesis is attached to the common femoral artery. The right superficial femoral artery is blocked proximally and a large profunda femoral artery fills collaterals that eventually fill the anterior tibial and the common peroneal artery. The anterior tibial artery is blocked and eventually collateral vessels through the posterior tibial artery and the proximal anterior tibial artery fill the distal anterior tibial artery. Collateral vessels also fill the posterior tibial artery, which is widely patent into the foot. On the left, there is multilevel plaque disease demonstrated in the distal superficial femoral artery. The popliteal artery, posterior tibial and common peroneal arteries have a normal appearance. The anterior tibial artery is blocked proximally. There is runoff down through the posterior tibial artery into the foot.
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Answer: Neither alternative is correct. The documentation contained in the report indicates that the catheter was advanced only into the aorta and no further. Therefore, the surgical or catheter-placement work would be reported with 36200 (introduction of catheter, aorta).
However, the documentation provided is incomplete and does not indicate the correct choice for the radio-logical supervision and interpretation code. It would be correct to assign 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) and 75716 (angiography, extremity, bilateral, radiological supervision and interpretation) only if the catheter had been repositioned into the infrarenal abdominal aorta or the proximal portion of the aorta bifemoral graft. However, there is no mention of this in the report.
Codes 36245 (selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) and 75710 (angiography, extremity, unilateral, radiological supervision and interpretation) would not be correct. Catheter placement in the aorta is non-selective, thereby making 36245 inaccurate. In addition, 75710 does not specifically describe the extent of the aortography performed. | |
