Wiki 36245, 75630-26

[amym]

I am new to interventional cardiology and need help coding this scenario:

PROTOCOL: The patient was brought to the peripheral vascular lab, was
prepped and draped in the usual sterile fashion. Xylocaine was
infiltrated in the left groin and left access was obtained with a 5-
French sheath. There was a tortuosity in the iliac vessel, which was
maneuvered with a glidewire. Subsequent exchanges were done with a
standard J-wire. JL4/JR4 and pigtail catheters were used for
angiography for the cardiac cath part.

Subsequently the catheter was exchanged to a OmniFlush 5French catheter,
which was placed at the level of L1 and an abdominal aortogram was
performed. Subsequently catheter was pulled back up to the level of
both bifurcations at the level of L4 and L5. Then subsequently runoff
was performed using 80 mL of contrast in a bolus chase fashion and
imaging was performed. After completion of the procedure the sheath was
removed and no complications occurred.

CARDIAC CATHETERIZATION: The cardiac catheterization will be reported
separately under digital processing.

VASCULAR IMAGING: The abdominal aortogram revealed presence of mild to
moderate disease in the abdominal aorta below the diaphragm. Both renal
arteries are small and show mild to moderate disease with no significant
stenosis. The bifurcation appears intact with calcification and acute
angle.

RIGHT LOWER EXTREMITY CIRCULATION: The right common iliac artery shows
heavy calcification and mild disease, leading up to a straighter segment
at the level of the external iliac. The internal iliac is patent with
no disease and subsequently the common femoral artery bifurcates
normally at the level of the femoral head. The superficial femoral
artery shows the proximal segment to be normal, which is followed by
total occlusion in the upper third, which is subsequently a long
occlusion with reconstitution of at the level of the popliteal artery
via collaterals from the profunda and then subsequently the popliteal
artery. Severe disease in the trifucation is noted, however, on the
right side there is a lead take off of the anterior tibial, which is
totally occluded proximally. The tibioperoneal trunk shows 99% stenosis
and followed by take off of a posterior tibial artery, which looks very
good and follows all the way to the foot and supplies the posterior arch
without any significant disease and reconstitution of the anterior
tibial noted above the ankle as well and so therefore at least one good
vessel runoff is present in the right leg.

LEFT LOWER EXTREMITY CIRCULATION: The left common iliac is tortuous and
shows at least 40 to 50% disease at this tortuosity followed by external
iliac artery, which reveals heavy disease and at the level of common
femoral artery there is a 70% stenosis, which is followed by superficial
femoral artery which is showing heavy disease up to 80 to 90% severity
in the middle third and lower third sections. Subsequently the
popliteal artery is relatively free of disease and followed by a severe
trifurcation disease with almost near-total occlusion of the popliteal
artery at the level of the anterior tibial take off. The anterior
tibial is totally occluded. The posterior tibial artery is totally
occluded. The peroneal artery is also totally occluded and
reconstitutes above the ankle with both anterior tibial and posterior
tibial arteries with slow flow into the foot.

Would this be reported as 36245, 75630-26?

Thanks

 

[rpcarrillo]

I would code this as 36200, 75625, 75716.

You have a high and low aortogram, in which case you would forego the 75630 and use the 75625/75716 instead.

Very important to key on though is this small but critical mention, "CARDIAC CATHETERIZATION: The cardiac catheterization will be reported separately under digital processing."

This tells you there was a concomitant cardiac cath performed at the same encounter as the aortogram. This is important because if the payer is Medicare, you will end up with different codes for this encounter. You'd need to investigate this further because you may have to instead report the codes for the cardiac cath, drop the 36200, and substitute G0275 and G0278 instead of 75625 and 75716 for the high and low non-selective aortogram.

Hope this helps.

 

[amym]

CATH was performed at the time of service. Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245? Would it be appropriae to append -59 mod to 36200?

 

[Jim Pawloski]

CATH was performed at the time of service. Is there a reason you are coding this as a non-selective angiogram 36200 as oppose to selective 36245? Would it be appropriae to append -59 mod to 36200?

As to the report, nothing was selected in the abdomen. So you have catheter, aorta with modifier -59.

 

[amym]

I'm sorry, just to clear it all up. I should bill:

36200-59
G0275
G0278

since cath was done same day.

 

[kgodda1]

I'm sorry, just to clear it all up. I should bill:

36200-59
G0275
G0278

since cath was done same day.

In this case you should only bill G0275 and G0278 since the cardiac cath was done on the same day. CPT 36200 would bundle into the cardiac cath CPT codes, and in this specific case there would not be justification to bill 36200-59.

Katie Goddard, CPC
Compliance Specialist
Mercy Health Services