Oscar Posted Fri 10th of November, 2017 04:50:33 AM
Dear Supercoder team
Please answer following coding scenario, my doctor has performed...
1) Abdominal Aortic Angiography
2) Bilateral Iliac Artery Angiography.
3) Selective bilateral lower extremity Angiography.
4) Selective right femoral Artery Angiography.
Following is the brief of procedure.
Right femoral artery access obtained via 7cm thinwall and 5F pinnacle sheath inserted in RFA. Then 5F pigtail catheter inserted and advanced to abdominal aorta and abdominal aortic angiogram performed. Catheter pulled back to Aortic bifurcation and bilateral iliac angiogram performed. Then catheter and wire advanced to left lower extremity and selective left lower extremity angiogram performed. That's all my doctor has given about left lower extremity selectivity. I requested more detail about left selectivity. Then catheter pulled back to sheath in Right femoral artery and selective right lower extremity angiogram performed.
Low osmolar contrast Omnipaque 300 used for about 100ml.
In this situation following is my coding.
Q9967-100 units for contrast.
36245-LT as doctor didn't give the selectivity and mentioned only advanced to LLE. If doctor gives more detail selectivity I will code accordingly.
In this situation my doubt is, should I code Right lower extremity femoral selectivity or cath order as it is done through sheath? If I have to report is 36246-RT is a right option. Please answer asap. Major doubt is sheath through angiograms are coded with selectivity codes or not?
SuperCoder Answered Mon 13th of November, 2017 06:44:15 AM
Based on the information provided, the only codes that should be reported are 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) and 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation) with modifier -26 (Professional component) appended. There is no additional payment allowed for placing the sheath into the extremity artery, so 36140 (Introduction of needle or intracatheter; extremity artery) should not be reported separately. In this case, access was obtained from right femoral artery, and the final point of reach was the iliac artery. Therefore, the entire procedure was performed in single session, with which, only a first-order selective code (36245) should be reported. Any other injection procedure performed during this procedure (same operative session), should be considered as inclusive in the major procedure.
Hope this helps!