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Aortoiliac Peripheral Vascular Disease

Teresa Posted Tue 18th of May, 2010 14:09:08 PM

Please help me with this procedure.
1)Ultrasound guided access to the left common femoral artery.
2)Selective Angiography of the left external iliac artery.
3)Attempted failed attempt to cross the chronic total occlusion.
The patient is coming back for an Aorta-Bifemoral Bypass after cardiac clearance. What procedure code would you use?
Thanks in advance for your help with this coding question.
Teresa Cooper

SuperCoder Answered Tue 18th of May, 2010 14:48:13 PM

Per my understanding, this can be coded as --> 35540 (for aorto-bifemoral), 75726 (angiography), 76942 - 59 (US guidance). Another point to consider: as an attempt was made and the procedure failed after anesthesia; so if the physician had elected to discontinue the procedure after failed attempts, you may add modifier 53 to the code 35540, to show that the procedure was ultimately not completed.

Harish Answered Wed 19th of May, 2010 03:42:58 AM

I would code 36140 and 75710.

This HCPCS coding clinic might help you.

A patient was seen at our facility for a planned femoral angioplasty and angiography. The angiography was completed but the angioplasty was not started because the physician could not cross the lesion with the wire.
Would it be appropriate to append modifier 74 in this instance?

Answer
Report CPT code 75710, Angiography, extremity, unilateral, radiological supervision and interpretation, for the angiography performed. Although, the angioplasty was planned, it was not started, and therefore, would not be reported.

Harish Answered Wed 19th of May, 2010 04:54:04 AM

And, we can not code separately for the US guidance in this case, as per Medlearn Interventional Radiology Coder.."many interventional procedures require contrast injections for localization and/or guidance. Unless there are CPT instructions directing the physician to report specific CPT codes for the localization or guidance, the localization or guidance is integral to the interventional procedure and is not separately reportable".

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