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Prahlad Posted Fri 07th of June, 2019 03:59:16 AM
1) Covered Stent Placement to the left subclavian/axillary artery due to inadvertent catheter placement with 8-French sheath. This is an 8x 40 Viabahn postdilated with 7.0 ballon. 2) Selective angiogram of the left subclavian artery. 3) Ascending thoracic angiogram 4) Left common femoral arteriogram. How to code
SuperCoder Answered Mon 10th of June, 2019 10:56:05 AM

For Stent Placement to the subclavian artery, CPT 37236 can be billed as in this procedure the provider inserts a stent in an artery using a catheter. Access may be either open or percutaneous. It includes any radiologic imaging to complete the procedure and if the provider performs angioplasty within the same vessel.

As left subclavian artery considered as 1st order vascular family, so CPT 36215 can be used for selective angiogram of the subclavian artery. In this procedure, the provider advances a catheter into each first order thoracic or brachiocephalic branch within a vascular family and performs angiography of the selected artery.

Ascending thoracic angiogram, seems type error, it might be ascending thoracic aortic angiogram. For whole of the aortic angiogram, CPT 36200 is appropriate. In this procedure, the provider inserts a catheter into a distal artery and then into the aorta. He uses a needle and inserts a guidewire into the needle. The provider performs the procedure for aortography or for measuring pressure inside aorta.

For left common femoral arteriogram, guidelines lead to CPT 36140. In this procedure, the provider enters through a puncture in the skin over an upper or lower extremity artery (femoral in your case), the physician injects a needle into the artery and threads a guidewire through it. The needle is removed. A catheter follows the wire into the artery and the wire is removed. Contrast material for arteriography is injected into the catheter placed upstream of the site under investigation. Once the procedure is complete, the catheter is removed, and pressure is applied to stop bleeding at the injection site. In this case, if radiological supervision and interpretation also has been performed then use code 75710 or 75716.

If these procedures are performed under same session, then as per CCI edits guidelines, code 36200 is a column 2 code for 36215, use modifier 59 with CPT 36200 in order to differentiate between the services provided.

Also, code 36140 is a column 2 code for 36215, use modifier 59 with CPT 36140 in order to differentiate between the services provided. It is suggested to keep your documentation strong enough to support the medical necessity.

Hope this helps!

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