Elizabeth83
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I have a case where the doctor is treating the patient for severe hand pain/ thrombus of radial artery.
1. Right femoral artery access.
2. Catheter placement in thoracic arch.
3. Arch angiogram.
4. Angiography subclavian and upper extremity
4. Selection of left radial artery, third order.
5. Selective left upper extremity angiogram.
6. Thrombolysis infusion.
7. Fluoroscopy.
emoral artery
My question would be is it appropriate to bill 36221 or even 36225 in addition to the selection of 36217 and the treatment codes? I can't seem to find any material for this scenario.
Thank you
The patient was taken to the angio suite and placed
in the supine position on the table. The right groin was prepped and
draped in the usual sterile manner. One percent Xylocaine was used to
anesthetize the femoral region. A Seldinger needle was used to access the
femoral artery. A guidewire was placed through the needle into the
thoracic arch confirmed by fluoroscopy. A needle was replaced in the
4-French sheath. Over the wire and through the sheath, a flush catheter
was placed and a thoracic arch angiogram performed. There was no evidence
of high-grade stenosis in the ostial takeoff of the great vessels. With a
JV-2 catheter the left subclavian artery and eventually radial artery were
selected third order. Left upper extremity angiogram showed no evidence of
stenosis at the subclavian artery takeoff with adequate flow through the
axillary and brachial vessels. Multiple collaterals were noted to be
present in the forearm. Distal forearm and hand films revealed some
chronic-appearing thrombus within the radial as well as near occlusion of
the ulnar arteries. There was retrograde filling of the ulnar, small
digital artery filling and multiple collaterals throughout the forearm and
hand. With a Glidewire the catheter was then used to select the radial
artery. With the radial artery and brachial artery transverse including a
portion of the thrombosed radial, a 135, 5 cm infusion catheter was placed
within the brachial artery into the takeoff of the radial artery.
Thrombolysis infusion was initiated. The plan is for followup angiogram
later on this afternoon. The patient tolerated the procedure well.
1. Right femoral artery access.
2. Catheter placement in thoracic arch.
3. Arch angiogram.
4. Angiography subclavian and upper extremity
4. Selection of left radial artery, third order.
5. Selective left upper extremity angiogram.
6. Thrombolysis infusion.
7. Fluoroscopy.
emoral artery
My question would be is it appropriate to bill 36221 or even 36225 in addition to the selection of 36217 and the treatment codes? I can't seem to find any material for this scenario.
Thank you
The patient was taken to the angio suite and placed
in the supine position on the table. The right groin was prepped and
draped in the usual sterile manner. One percent Xylocaine was used to
anesthetize the femoral region. A Seldinger needle was used to access the
femoral artery. A guidewire was placed through the needle into the
thoracic arch confirmed by fluoroscopy. A needle was replaced in the
4-French sheath. Over the wire and through the sheath, a flush catheter
was placed and a thoracic arch angiogram performed. There was no evidence
of high-grade stenosis in the ostial takeoff of the great vessels. With a
JV-2 catheter the left subclavian artery and eventually radial artery were
selected third order. Left upper extremity angiogram showed no evidence of
stenosis at the subclavian artery takeoff with adequate flow through the
axillary and brachial vessels. Multiple collaterals were noted to be
present in the forearm. Distal forearm and hand films revealed some
chronic-appearing thrombus within the radial as well as near occlusion of
the ulnar arteries. There was retrograde filling of the ulnar, small
digital artery filling and multiple collaterals throughout the forearm and
hand. With a Glidewire the catheter was then used to select the radial
artery. With the radial artery and brachial artery transverse including a
portion of the thrombosed radial, a 135, 5 cm infusion catheter was placed
within the brachial artery into the takeoff of the radial artery.
Thrombolysis infusion was initiated. The plan is for followup angiogram
later on this afternoon. The patient tolerated the procedure well.