margaret fahy
Guru
10/24/13
Hi, Guys,
Want to be sure re coding below...Renal Angiographies...one done from Aorta, the other selective caths of the Renals. Then a Renal Angioplasty.
How bad off am I with these codes?
36252, 35471, 75966........
With cath in aorta and renal angiographies done, this is not to be coded as renal angiography, right?
Can someone please take a look?
Thanks.
Margie
PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Selective catheterization of the right renal artery and
angiogram.
5. Angioplasty of the main right renal artery using 2.5 mm, 3 mm
balloon catheters.
6. Post angioplasty angiogram of the right renal artery.
7. Post angioplasty abdominal aortogram.
8. Hemostasis with manual compression.
PROCEDURE IN DETAILS: The skin of the right groin was prepped
and draped in sterile fashion. Using US guidance a 21-gauge
needle was inserted in the right common femoral artery. Once
arterial blood return was obtained a .018" Nitrex wire was
placed into the artery and advanced to the distal abdominal
aorta. The needle was removed and a 4 French regular vascular
sheath was placed into the artery. Then a 4 French 70 cm pigtail
catheter was advanced into the proximal abdominal aorta and
angiogram of the lower abdominal aorta and renal arteries in
frontal and oblique views were obtained utilizing digital
subtraction angiography. The vascular sheath was exchanged into
5 French, 45 cm curved vascular sheath which advanced over the
wire into the lower abdominal aorta. The catheter was
exchanged into 4 French Sos Omni catheter and selective
catheterization of the left renal artery was performed and
angiogram was obtained in oblique positions utilizing digital
subtraction angiography. Then the right renal artery was
catheterized and angiogram was obtained in oblique positions
utilizing digital subtraction angiography.
FINDINGS:
AORTOGRAM:
The abdominal aorta, visualized branches of the celiac artery
and SMA and aortic bifurcation are normal in caliber without
evidence of stenosis.
LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. There is no significant stenosis at the origin.
There is minimal irregularity of the wall of the main renal
artery, with no evidence of significant stenosis. There is mild
irregularity in the wall and uneven diameter of intrarenal
branches including lobar, interlobar and marginal arteries. This
is associated with mild hypo-perfusion areas along the periphery
of the left kidney There is no vascular malformation or
aneurysm. The left renal vein is unremarkable.
RIGHT RENAL ARTERY ANGIOGRAM: There are main right renal artery
and accessory small renal artery supplying the inferior pole.
There is moderate diffuse narrowing and irregularity involving
the right main renal artery and extending into the origin of the
inferior branch. There is mild irregularity in the wall and
uneven diameter of intrarenal branches including lobar,
interlobar and marginal arteries. This is associated with mild
hypoperfused areas along the periphery of the right kidney.
There is no vascular malformation or aneurysm. The right renal
vein is unremarkable.
The venous phase demonstrates patent renal veins and suprarenal
IVC. There is no significant discrepancy in renal size.
RIGHT RENAL ANGIOPLASTY:
The images were reviewed carefully and the decision of
angioplasty of the right renal artery was made. The initial dose
of heparin was given. A 014" Thruway wire was advanced into the
main right renal artery and then into the branch. Angioplasty
of the main right renal artery was performed utilizing 2.5 mm
(max inflation to 14 Atm 2.7mm) and 3 mm Monorail balloon
catheter (inflated to 3mm). Post angioplasty angiogram
demonstrated significant radiologic improvement of the stenosis
without evidence of thrombosis or extravasation. There was
moderate arterial spasm involving the inferior branch of the
main right renal artery.
The sheath and the wire were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. The ACT at the time of leaving
the IR suite was 277 secs.There were no complications and the
patient left the IR Suite in stable condition. Dr.was present for entire procedure.
Hi, Guys,
Want to be sure re coding below...Renal Angiographies...one done from Aorta, the other selective caths of the Renals. Then a Renal Angioplasty.
How bad off am I with these codes?
36252, 35471, 75966........
With cath in aorta and renal angiographies done, this is not to be coded as renal angiography, right?
Can someone please take a look?
Thanks.
Margie
PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Selective catheterization of the right renal artery and
angiogram.
5. Angioplasty of the main right renal artery using 2.5 mm, 3 mm
balloon catheters.
6. Post angioplasty angiogram of the right renal artery.
7. Post angioplasty abdominal aortogram.
8. Hemostasis with manual compression.
PROCEDURE IN DETAILS: The skin of the right groin was prepped
and draped in sterile fashion. Using US guidance a 21-gauge
needle was inserted in the right common femoral artery. Once
arterial blood return was obtained a .018" Nitrex wire was
placed into the artery and advanced to the distal abdominal
aorta. The needle was removed and a 4 French regular vascular
sheath was placed into the artery. Then a 4 French 70 cm pigtail
catheter was advanced into the proximal abdominal aorta and
angiogram of the lower abdominal aorta and renal arteries in
frontal and oblique views were obtained utilizing digital
subtraction angiography. The vascular sheath was exchanged into
5 French, 45 cm curved vascular sheath which advanced over the
wire into the lower abdominal aorta. The catheter was
exchanged into 4 French Sos Omni catheter and selective
catheterization of the left renal artery was performed and
angiogram was obtained in oblique positions utilizing digital
subtraction angiography. Then the right renal artery was
catheterized and angiogram was obtained in oblique positions
utilizing digital subtraction angiography.
FINDINGS:
AORTOGRAM:
The abdominal aorta, visualized branches of the celiac artery
and SMA and aortic bifurcation are normal in caliber without
evidence of stenosis.
LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. There is no significant stenosis at the origin.
There is minimal irregularity of the wall of the main renal
artery, with no evidence of significant stenosis. There is mild
irregularity in the wall and uneven diameter of intrarenal
branches including lobar, interlobar and marginal arteries. This
is associated with mild hypo-perfusion areas along the periphery
of the left kidney There is no vascular malformation or
aneurysm. The left renal vein is unremarkable.
RIGHT RENAL ARTERY ANGIOGRAM: There are main right renal artery
and accessory small renal artery supplying the inferior pole.
There is moderate diffuse narrowing and irregularity involving
the right main renal artery and extending into the origin of the
inferior branch. There is mild irregularity in the wall and
uneven diameter of intrarenal branches including lobar,
interlobar and marginal arteries. This is associated with mild
hypoperfused areas along the periphery of the right kidney.
There is no vascular malformation or aneurysm. The right renal
vein is unremarkable.
The venous phase demonstrates patent renal veins and suprarenal
IVC. There is no significant discrepancy in renal size.
RIGHT RENAL ANGIOPLASTY:
The images were reviewed carefully and the decision of
angioplasty of the right renal artery was made. The initial dose
of heparin was given. A 014" Thruway wire was advanced into the
main right renal artery and then into the branch. Angioplasty
of the main right renal artery was performed utilizing 2.5 mm
(max inflation to 14 Atm 2.7mm) and 3 mm Monorail balloon
catheter (inflated to 3mm). Post angioplasty angiogram
demonstrated significant radiologic improvement of the stenosis
without evidence of thrombosis or extravasation. There was
moderate arterial spasm involving the inferior branch of the
main right renal artery.
The sheath and the wire were then removed and manual compression
was applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. The ACT at the time of leaving
the IR suite was 277 secs.There were no complications and the
patient left the IR Suite in stable condition. Dr.was present for entire procedure.