Wiki Billing LE Angiogram

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amym

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What can I code in addition to 36200? Thanks.

PROTOCOL: The patient was brought to the cath lab after written consent
was obtained. Both groins were prepped and draped in the usual fashion.
The left common femoral artery was cannulated without difficult. A 5-
French sheath was placed. A 5-French OmniFlush catheter was then
advanced. Imaging was obtained with the catheter placement at level of
L1 and then subsequently pulled back above the bifurcation. Bolus chase
method was used for angiography. No complications occurred. After
completion of the procedure the sheath was removed with manual
compression.

FINDINGS:
1. The aorta demonstrates normal caliber with no significant disease.
2. The left renal artery is patent. The right renal artery demonstrated
40 to 50% plaque in the proximal segment. The remaining portion of the
descending aorta is normal.
3. The right extremity reveals the following: Common iliac artery is
patent. The right internal iliac artery is occluded. Right external
iliac artery is patent with good flow with mild atherosclerosis. The
common femoral artery and right superficial femoral artery area showing
moderate disease of up to 40 to 50% plaque and focal areas within the
mid superficial femoral artery. The popliteal artery is widely patent
and the trifurcation is preserved with mild disease. The right anterior
tibial artery shows proximal 75 to 80% focal narrowing, which is leading
up to a three-vessel runoff in the lower extremity with mild disease in
the other vessels.
6. The left extremity reveals that left internal iliac artery shows 90%
stenosis. The left external iliac is patent and common femoral artery
is without any significant disease. Left superficial femoral artery
shows mild to moderate plaque with 30 to 40% plaque in the mid to mid-
distal segment and popliteal artery is unremarkable. The trifurcation
reveals left anterior tibial artery with 50 to 70% focal narrowing in
the mid segment. There is three-vessel runoff with minimal disease
affecting the posterior tibial and peroneal arteries and the arch is
intact with good flow to the foot.
 
He/she has results for the Bilateral extremity angiography's but his dictation does not seem to specifically mention his cath placement, unless I'm missing it. So you could possibly bill 75716 - 26, 59 as well.
 
jewlz0879 said:
He/she has results for the Bilateral extremity angiography's but his dictation does not seem to specifically mention his cath placement, unless I'm missing it. So you could possibly bill 75716 - 26, 59 as well.
Click to expand...

The catheter placements was mentioned when he stated about the imaging.

Jim Pawloski, CIRCC
 
amym said:
What can I code in addition to 36200? Thanks.

PROTOCOL: The patient was brought to the cath lab after written consent
was obtained. Both groins were prepped and draped in the usual fashion.
The left common femoral artery was cannulated without difficult. A 5-
French sheath was placed. A 5-French OmniFlush catheter was then
advanced. Imaging was obtained with the catheter placement at level of
L1 and then subsequently pulled back above the bifurcation. Bolus chase
method was used for angiography. No complications occurred. After
completion of the procedure the sheath was removed with manual
compression.

FINDINGS:
1. The aorta demonstrates normal caliber with no significant disease.
2. The left renal artery is patent. The right renal artery demonstrated
40 to 50% plaque in the proximal segment. The remaining portion of the
descending aorta is normal.
3. The right extremity reveals the following: Common iliac artery is
patent. The right internal iliac artery is occluded. Right external
iliac artery is patent with good flow with mild atherosclerosis. The
common femoral artery and right superficial femoral artery area showing
moderate disease of up to 40 to 50% plaque and focal areas within the
mid superficial femoral artery. The popliteal artery is widely patent
and the trifurcation is preserved with mild disease. The right anterior
tibial artery shows proximal 75 to 80% focal narrowing, which is leading
up to a three-vessel runoff in the lower extremity with mild disease in
the other vessels.
6. The left extremity reveals that left internal iliac artery shows 90%
stenosis. The left external iliac is patent and common femoral artery
is without any significant disease. Left superficial femoral artery
shows mild to moderate plaque with 30 to 40% plaque in the mid to mid-
distal segment and popliteal artery is unremarkable. The trifurcation
reveals left anterior tibial artery with 50 to 70% focal narrowing in
the mid segment. There is three-vessel runoff with minimal disease
affecting the posterior tibial and peroneal arteries and the arch is
intact with good flow to the foot.
Click to expand...

I would bill 36200, 75625, and 75716. Catheter was moved into two positions, so you get an Abdominal Aortogram and Bilateral Extremity Arteriogram
HTH,
Jim Pawloski, CIRCC
 
So do you only have to append 59 when billing 75710/75716 with the Lower Extremity Revascularizations 37220 - 37235?

I thought with the new rules 75625/75630 & 75710/75716 were bundled so you have to use 59? Would love to have a better understanding. Thanks!
 
jewlz0879 said:
So do you only have to append 59 when billing 75710/75716 with the Lower Extremity Revascularizations 37220 - 37235?

I thought with the new rules 75625/75630 & 75710/75716 were bundled so you have to use 59? Would love to have a better understanding. Thanks!
Click to expand...

What is bundled with the revascularization codes is the catheterization codes. As long as there is a diagnostic arteriogram before the intervention. So yes, you use modifier-59 for the diagnostic portion when the lower extremity intervention is performed.
HTH,
Jim Pawloski, CIRCC
 
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