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Posted By kimberly on 06-08-2005, 19:12:00 in Cardiology
can someone help me with this:

a 5-french sheath was inserted into the left femoral artery using the
seldinger technique without difficulty. abdominal aortogram was then
performed in the ap position with pigtail catheter, with lower extremity
run-off. then selective angiography to the left femoral arterial sheath
was done, with long leg run-off. then a 5-french lima catherter was placed
in the right iliac and a selective angio was done on the right leg was
performed with run-off.

findings: the aorta had moderate atherosclerotic disease, but no
obstructive lesion, no aneurysm. there was about 50% in the left iliac.
with total occlusion in the left sfa with reconstitution down just in the
very distal aspect of the left sfa. there were patent bilateral renal
arteries. the right iliac had 95% very tight stenosis in it's mid
segment.about 60-70% stenosis in the right common femoral just before the
anastomosis of the fem-pop bypass graft. which was patent. the right sfa
was totally occluded. there was 99% stenosis in the right anterior tibial
total occlusion of what looked like the right posterior tibial.

75630.26,(you lose due to the selective)
36426lt
36247rt
75716.26

medicare pt, no left heart cath.


thanks....


Comments (4)
Posted By Julie on 06-09-2005, 14:51:00
Thanks-I just wanted to clarify when people are using the G codes (which are
totally confusing!!!)



Julie Wagner RHIT, CCS-P

Fond du Lac Regional Clinic

Clinic Hospital Coding

(920) 926-8337

(920) 926-8905 Fax

wagnerju@agnesian.com
Posted By Julie on 06-09-2005, 13:41:00
Not to continue to be a pain but I am thinking that G0275 wouldn't be
appropriate because there was no mention of the renals and that clearly
wasn't his intent. Is that correct?

Thanks for clarifying that other information for me. I think I finally
understand.

Julie Wagner RHIT, CCS-P
Fond du Lac Regional Clinic
Clinic Hospital Coding
(920) 926-8337
(920) 926-8905 Fax
wagnerju@agnesian.com
Posted By Mary on 06-09-2005, 13:36:00
Hi Deb, welcome back. Can I throw a monkey wrench into this...what if
you have the same scenario as described below but it was done during a LHC
on a MCR patient. Would you then code:

G0275 (abd aorto)
G0278 (runoffs/ipsil iliac)
36245 (contralat iliac)
75774 (contralat iliac)

Thanks
Mary


A pullback to the access sheath is not selective, no matter if the doc states it as such.

From what you have given us, I would code:
75630 (you don't lose the abdominal aorta part of this unless the renals
are selected. The extremity part does not operate under the same rule, only the cath placement part (36200).)
36245 (the right common iliac is not a third order vessel, it's a first.
He doesn't state how far he went, so I'm assuming common, you may want to
clear this up with him. If he went to the external, your code is 36246,
second order)(this selective cath placemetn into the leg is why 36200
goes away)
75774--further selective angiogram in the right leg after basic exam (75630).
Deb Ovall, CMA, CCS, CIC
Lead Coder and Data Quality Analyst
Medical University Hospitals of Ohio at Toledo
419-383-3965

>
Posted By Julie on 06-09-2005, 10:32:00
I agree but you should also bill 75625 for the abdominal aortogram. Does
anyone else agree?

Julie Wagner RHIT, CCS-P
Fond du Lac Regional Clinic
Clinic Hospital Coding
(920) 926-8337
(920) 926-8905 Fax
wagnerju@agnesian.com
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