I know 75650 for arch aortogram has been deleted and now included in carotid angio codes. But how would you code the arch aortogram when performed with Thoracic arteriogram? Copy of OP Report below. Thank you for your time in this matter.
Procedure performed: Thoracic arteriogram with selective arch vessel cannulation and abdominal aortogram
Detailed procedure:
1- Ultrasound guided access of vessel
2- Placement of a catheter in the right brachial artery (3rd order)
3- Placement of a catheter in the left brachial artery (3rd order)
4- Placement of a catheter in the abdominal aorta (non-selective cannulation)
5- Radiographic supervision and interpretation of an arch aortogram with 2 vessel selective catheter placement
6- Radiographic supervision and Interpretation of aortogram of the abdomen
Details of procedure:
Following informed consent, the patient was properly identified and placed supine on the procedure table. Time out was called to confirm the proper patient, procedure, allergies and perioperative antibiotics. The groins were then prepped and draped sterilely. Lidocaine was used to anesthetize the skin. Ultrasound was utilized to identify the vessels and a needle inserted under direct ultrasound guidance. A micropuncture sheath was then placed and exchanged for a 4 French sheath using Seldinger technique. A guidewire was then advanced and a flush catheter positioned in the ascending aorta. An aortogram was then performed. The catheter was then exchanged for a diagnostic catheter using the support of the guidewire. We then engaged the innominate artery and were able to manipulate our guidewire and catheter into the right brachial artery where hand injection performed at that level to image the right arm. We then repositioned the catheter and the left brachial artery an additional imaging performed to image the left arm.. The guidewire was then readvanced and the catheter removed. we then advanced a pigtail catheter into the abdominal aorta whwere a flush aortogram was performed. The sheath was then removed and a Perclose along with manual pressure utilized for hemostasis upon completion. Heparin was not reversed at the termination of the procedure.
Radiographic findings:
1- Patent femoral artery by ultrasound
2- Arch Aortogram: this demonstrates a patent aortic arch. The arch anatomy is abnormal. The common carotid arteries appear to share a common orifice off the ascending aorta. The subclavian arteries appear to share a common orifice off the transverse aorta. There is no evidence of possible arch vessel disease. No evidence of aneurysm formation.
3- Right upper extremity imaging: this demonstrates a patent subclavian, axillary, and brachial system. The vertebral and internal mammary vessels filled on this injection without obvious possible disease. There is no aneurysm formation or significant occlusive disease noted within these vessels. The brachial artery bifurcates at the antecubital crease. Of note the brachial artery appeared small. Similarly, the radial and ulnar vessels are small but remained patent to the wrist. There is a single palmar arch identified. This may represent the deep palmar arch emanating from the radial artery.
4- Left upper extremity imaging: This demonstrates a patent subclavian, axillary, and brachial system. The internal mammary vessels filled on this injection without obvious possible disease. There is no aneurysm formation or significant occlusive disease noted within these vessels. The brachial artery bifurcates at the and upper arm. There is a patent basilic vein fistula which appears to emanate from the radial artery at the elbow. The ulnar artery crosses the elbow giving rise to a profunda radii branch and appears to be the only patent vessel to the wrist. The radial artery occludes shortly after the AV fistula anastomosis. Repeat imaging with attempted compression failed to image the radial artery distally. Of note the ulnar artery appears small.
5- Aortogram- this demonstrates a patent abdominal aorta and iliac vessels bilaterally. There is no significant occlusive disease noted. The hypogastric artery appears small. There is no aneurysm formation.
Procedure performed: Thoracic arteriogram with selective arch vessel cannulation and abdominal aortogram
Detailed procedure:
1- Ultrasound guided access of vessel
2- Placement of a catheter in the right brachial artery (3rd order)
3- Placement of a catheter in the left brachial artery (3rd order)
4- Placement of a catheter in the abdominal aorta (non-selective cannulation)
5- Radiographic supervision and interpretation of an arch aortogram with 2 vessel selective catheter placement
6- Radiographic supervision and Interpretation of aortogram of the abdomen
Details of procedure:
Following informed consent, the patient was properly identified and placed supine on the procedure table. Time out was called to confirm the proper patient, procedure, allergies and perioperative antibiotics. The groins were then prepped and draped sterilely. Lidocaine was used to anesthetize the skin. Ultrasound was utilized to identify the vessels and a needle inserted under direct ultrasound guidance. A micropuncture sheath was then placed and exchanged for a 4 French sheath using Seldinger technique. A guidewire was then advanced and a flush catheter positioned in the ascending aorta. An aortogram was then performed. The catheter was then exchanged for a diagnostic catheter using the support of the guidewire. We then engaged the innominate artery and were able to manipulate our guidewire and catheter into the right brachial artery where hand injection performed at that level to image the right arm. We then repositioned the catheter and the left brachial artery an additional imaging performed to image the left arm.. The guidewire was then readvanced and the catheter removed. we then advanced a pigtail catheter into the abdominal aorta whwere a flush aortogram was performed. The sheath was then removed and a Perclose along with manual pressure utilized for hemostasis upon completion. Heparin was not reversed at the termination of the procedure.
Radiographic findings:
1- Patent femoral artery by ultrasound
2- Arch Aortogram: this demonstrates a patent aortic arch. The arch anatomy is abnormal. The common carotid arteries appear to share a common orifice off the ascending aorta. The subclavian arteries appear to share a common orifice off the transverse aorta. There is no evidence of possible arch vessel disease. No evidence of aneurysm formation.
3- Right upper extremity imaging: this demonstrates a patent subclavian, axillary, and brachial system. The vertebral and internal mammary vessels filled on this injection without obvious possible disease. There is no aneurysm formation or significant occlusive disease noted within these vessels. The brachial artery bifurcates at the antecubital crease. Of note the brachial artery appeared small. Similarly, the radial and ulnar vessels are small but remained patent to the wrist. There is a single palmar arch identified. This may represent the deep palmar arch emanating from the radial artery.
4- Left upper extremity imaging: This demonstrates a patent subclavian, axillary, and brachial system. The internal mammary vessels filled on this injection without obvious possible disease. There is no aneurysm formation or significant occlusive disease noted within these vessels. The brachial artery bifurcates at the and upper arm. There is a patent basilic vein fistula which appears to emanate from the radial artery at the elbow. The ulnar artery crosses the elbow giving rise to a profunda radii branch and appears to be the only patent vessel to the wrist. The radial artery occludes shortly after the AV fistula anastomosis. Repeat imaging with attempted compression failed to image the radial artery distally. Of note the ulnar artery appears small.
5- Aortogram- this demonstrates a patent abdominal aorta and iliac vessels bilaterally. There is no significant occlusive disease noted. The hypogastric artery appears small. There is no aneurysm formation.