Wiki cervical arch, R cartoid & R femoral arteriogram

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decus1956

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Help again....

My doctor did RH &LH cath w/coronaries.

The he positioned cath in L subclavian artery to evaluate origin of subclavian and takeoff of IMA. A L subclavian arteriogram was performed. In doing this, it was clear pt had tight L. vertebral artery at the ostium. Because of findings and pts history of vertebral basilar insufficiency, he elected to do a cervical arch arteriogram. Then he positioned cath in ascending aorta and digital substraction angiography was performed in LAO projection. This demonstrated origin of R innominate, L cartoid, which came off its usual origin and the L subclavian. R vertebral artery also appeared to have tight lesion in proximal portion. An attempt was made to cannulate ostium of R vertebral artery with cath, but was unsuccessful. A right femoral arteriogram was performed.

36221 cervical arch arteriogram
36222 R cartoid
36225 or 36215 ? L subclavian arteriogram
75716?
 
L Subclavian

deannegreen said:
Help again....

My doctor did RH &LH cath w/coronaries.

The he positioned cath in L subclavian artery to evaluate origin of subclavian and takeoff of IMA. A L subclavian arteriogram was performed. In doing this, it was clear pt had tight L. vertebral artery at the ostium. Because of findings and pts history of vertebral basilar insufficiency, he elected to do a cervical arch arteriogram. Then he positioned cath in ascending aorta and digital substraction angiography was performed in LAO projection. This demonstrated origin of R innominate, L cartoid, which came off its usual origin and the L subclavian. R vertebral artery also appeared to have tight lesion in proximal portion. An attempt was made to cannulate ostium of R vertebral artery with cath, but was unsuccessful. A right femoral arteriogram was performed.

36221 cervical arch arteriogram
36222 R cartoid
36225 or 36215 ? L subclavian arteriogram
75716?
Click to expand...

I would bill the R/L heart cath with code 36225 for L subclavian with imaging of L vertebral circulation. Reason being that the findings here are not actually of the arm. If the left subclavian artery arteriogram had documented findings of the extremity vessels then you could bill 36215/75710 instead of 36225.

The arch arteriogram 36221 is included in 36225 and not separately billable. I see an "attempt" to cannulate the R vertebral, however, since it was not successful this would not be billed. Also, I do not see in the note above where the right common carotid was selectively catheterized, so I would not bill 36222.

Final coding:
93460
36225

Hope this helps!
 
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