Wiki Cath + upper and lower angiographic study

[hshihabuddin@gmail.com]

Dear all,

I'm new to the forum and need your help to code for a Cath, Upper and Lower angiography procedure as follows:

75-year male with CAD, prior stents, presented with non-ST elevation MI and there is a severe claudication in bilateral stents in the lower extremities as well as R-Carotid stent significant, significant L-Carotid stenosis.

Coronary Angiography Findings;
1. The LM has 20% proximal disease
2. LAD has calcified 50% proximal and mid stenosis
3. LC has 50% calcified lesion in proximal to mid segment. OM3 is a large
artery with mild disease.
4. RCA is a tortuous vessel with stent in proximal, stent in mid and both a
patent with only 30 to 40% in-stent restenosis. Distal to stents are diet diffuse disease.

Carotid angiography:
1. There is widely patent stent in the R-Carotid artery with only 20% in-stent restenosis.
2.The right brachiocephalic artery has mild disease
3. The L-common Carotid is occluded at proximal
4. The Left subclavian has 50% stenosis. The left vertebral artery is widely patent.

Abdominal Aortography & Bileteral Iliofemoral angiography:
1. Stents in L&R iliac arteries are widely patent in the ostrium. Of the Left iliac artery, it has 50-60% disease at the proximal of the stent.
2. The right common femoral has 90% calcified disease.
3. The Right SFA has 50% calcified disease.
4. The distal left SFA was occluded. Just distal to occlusion, there is a stent in popliteal artery which it occluded.

There is severe infrapopliteal disease in both extremities with left lower extremity having zero vessel runoff with reconstitution distally.

Codes I thought to use are as follows:

1. 93458
2. 36222 - LT 50
36222 - RT
3. 36215 - 51
75710 - 59
4. 36247 - 51
75716 - 59
36247 51 59
75774 - 59

I would appreciates any thoughts from the forum.

 

[Jim Pawloski]

Dear all,

I'm new to the forum and need your help to code for a Cath, Upper and Lower angiography procedure as follows:

75-year male with CAD, prior stents, presented with non-ST elevation MI and there is a severe claudication in bilateral stents in the lower extremities as well as R-Carotid stent significant, significant L-Carotid stenosis.

Coronary Angiography Findings;
1. The LM has 20% proximal disease
2. LAD has calcified 50% proximal and mid stenosis
3. LC has 50% calcified lesion in proximal to mid segment. OM3 is a large
artery with mild disease.
4. RCA is a tortuous vessel with stent in proximal, stent in mid and both a
patent with only 30 to 40% in-stent restenosis. Distal to stents are diet diffuse disease.

Carotid angiography:
1. There is widely patent stent in the R-Carotid artery with only 20% in-stent restenosis.
2.The right brachiocephalic artery has mild disease
3. The L-common Carotid is occluded at proximal
4. The Left subclavian has 50% stenosis. The left vertebral artery is widely patent.

Abdominal Aortography & Bileteral Iliofemoral angiography:
1. Stents in L&R iliac arteries are widely patent in the ostrium. Of the Left iliac artery, it has 50-60% disease at the proximal of the stent.
2. The right common femoral has 90% calcified disease.
3. The Right SFA has 50% calcified disease.
4. The distal left SFA was occluded. Just distal to occlusion, there is a stent in popliteal artery which it occluded.

There is severe infrapopliteal disease in both extremities with left lower extremity having zero vessel runoff with reconstitution distally.

Codes I thought to use are as follows:

1. 93458
2. 36222 - LT 50
36222 - RT
3. 36215 - 51
75710 - 59
4. 36247 - 51
75716 - 59
36247 51 59
75774 - 59

I would appreciates any thoughts from the forum.

A full report would be very helpful, but in what you have given, I would code:
93454 - No documentation of LV gram or LVEDP
36222-50
36223 -lt
For Lower Extremity coding, I need to know where was access. Again, posting the report is helpful, so I can code catheter placements. As for imaging, I can only bill 75716.
Sorry,
Jim Pawloski, CIRCC

 

[hshihabuddin@gmail.com]

Thanks Jim,

The procedures performed were:
1. LHC
2. Selective L & R coronary angiography
3 Left ventriculography
4. Selective right & Left Carotid angiography
5. Selective Left subclavian angiography
6. Selective left iliofemoral angiography
7. Selective right femoropopliteal angiography
9. Lower abdominal aortography

The Interventional Cardiologist was requested to perform angiographic study will all the components above.

The Catheter was placed in the right common femoral.

In addition, the LV findings were LV gram showed mild inferior hypokinesis, ejection 50-55%. No MR and there is no gradient across the aortic valve. EDP was 8mmhg.

FINDINGS:
1. Moderate coronary disease in the main branches remain unchanged from previous Cath done in 2013(by another Cardiologist)
2. Stent in the right Carotid artery in widely patent
3. Left common Carotid is 100% totally Occluded chronically
4. Left subclavian 50% disease
5. Patent stent in iliac, however 90% calcified disease in the right common femoral. Left SFA is occluded distally
6. There is severe infrapopliteal disease bilaterally.

This is all the information I had to add-on what I sent earlier.

Once again, appreciate your feedback on this.

Hafidh

 

[Jim Pawloski]

Thanks Jim,

The procedures performed were:
1. LHC
2. Selective L & R coronary angiography
3 Left ventriculography
4. Selective right & Left Carotid angiography
5. Selective Left subclavian angiography
6. Selective left iliofemoral angiography
7. Selective right femoropopliteal angiography
9. Lower abdominal aortography

The Interventional Cardiologist was requested to perform angiographic study will all the components above.

The Catheter was placed in the right common femoral.

In addition, the LV findings were LV gram showed mild inferior hypokinesis, ejection 50-55%. No MR and there is no gradient across the aortic valve. EDP was 8mmhg.

FINDINGS:
1. Moderate coronary disease in the main branches remain unchanged from previous Cath done in 2013(by another Cardiologist)
2. Stent in the right Carotid artery in widely patent
3. Left common Carotid is 100% totally Occluded chronically
4. Left subclavian 50% disease
5. Patent stent in iliac, however 90% calcified disease in the right common femoral. Left SFA is occluded distally
6. There is severe infrapopliteal disease bilaterally.

This is all the information I had to add-on what I sent earlier.

Once again, appreciate your feedback on this.

Hafidh

I have to change the 36225 since the vertebral artery is not mentioned. Code the Lt subclavian 36215/ 75710 (which I think you did). For the lower extremity, I would code 36245 for catheter position and still bill 75716 for bilateral extremity angio.
Thanks for the report.
Jim Pawloski, CIRCC

 

[hshihabuddin@gmail.com]

Thanks Jim,

Appreciate your feedback