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Leorah Posted Tue 26th of September, 2017 03:46:38 AM
When coding a diagnostic cerebral angiogram can I code a 36245 with a 75736 when the catheter was inserted in the femoral or iliac artery and radiological supervision was performed? In addition, when performing an embolization of an aneurysm up to how many angiography 75898 codes can I use if the procedure was complicated and many coils needed to be inserted into the artery and then checked to see if normal blood flow had resumed?
SuperCoder Answered Wed 27th of September, 2017 07:37:21 AM

It’s tough to code the diagnostic angiography without more information (where did the catheter stop, which vessels were imaged/interpreted), but compare the documentation to the 3622x codes. Also check to see if there was an additional 75898-26 service.

For the embolization, compare the documentation to :
* 61626, Transcatheter permanent occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method; non-central nervous system, head or neck (extracranial, brachiocephalic branch)
* 75894-26, Transcatheter therapy, embolization, any method, radiological supervision and interpretation.

75898 multiple use:- If this is only a follow-up angiography through an existing catheter, then look to 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion). Append modifier 26 (Professional component).

You typically may report 75898 only once per operative field per session, according to CPT Assistant. 

The AMA doesn't include central nervous system or intracranial completion angiography in this "once per operative field" rule. When you do report more than one completion angiography on a claim, CPT Assistant recommends using modifier 59 (Distinct procedural service) on the second and subsequent code to indicate their distinct nature.

If there were additional services, then there will be additional codes. For instance, see this example:

30yo post MVA with suspected carotid cavernous fistula and weeping exophthalmos. Via bilateral femoral vein punctures, catheters are advanced up the jugular veins into the cavernous sinus bilaterally.

A catheter is placed via the femoral artery into both internal carotid arteries. Arterial imaging shows the fistula on the right and good cerebral filling without thrombus or occlusion and bilateral venous imaging showing retrograde filling of the opthalmic veins and rapid washout via the right side. The right side of the cavernous sinus is packed with coils to obliterate the fistula. Three follow‐up images are necessary. These show safe coil placement and no residual flow in the fistula.

Venous Head and Neck Case 9 Codes:
36012-50 – Bilateral venous catheter placement
36216 -59 – Left ICA catheter placement
36217 – Right ICA catheter placement
75671 – Bilateral cerebral angiography
75860, 75860-59 – Bilateral jugular venography
61624 – Intracranial embolization
75894 – Embolization S&I
75898,75898-59 x 2 – Follow-up embolotherapy per injection for cerebral therapy.

Hope that helps!

 

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