The 2006 Edition of Dr Z's Medical
Coding Series: Interventional Radiology Coding
Reference
Starts
Shipping Next Week!
- New
2006 code changes
- New
chapters on Percutaneous Thrombectomy &
Neurovascular Interventional procedures
- New
codes for intracranial intervention, urologic
intervention, kyphoplasty, etc. procedures
- New,
and expanded examples
- New
and updated coding sheets
- New
Terminology section
...and
much more
ZHealth Coding Question &
Answer for February
Below
is an example ZHealth Coding Question & Answer that
is posted online with hundreds of others for ZHealth
Online members. Remember if you sign up for ZHealth
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Coding Question: This
case is completely different from any other that I have
coded. I'm getting a little confused because of the
grafts that are being catheterized. The dictation reads:
PROCEDURES-AP and lateral abdominal aortogram, pelvic
angiogram, selective SMA bypass angiogram which arises
from the RT limb of the aortobifemoral bypass graft.
Access site RT femoral artery. An 0.035 J wire was
passed into the abdominal aorta and a #5 french sheath
was placed. Over the wire, a 5 french pigtail
catheter was placed into the proximal abdominal aorta
and AP & lateral abdominal aortograms were perfomed.
Findings are compatible with occlusions of the Celiac
and IMA. The patients right limb to SMA bypass
graft does not opacify. To better evaluate the
bypass graft, the catheter was placed into distal
portion of the aortobifemoral bypass graft and AP and
oblique pelvic digital angiogram was performed. This
demonstates the limbs of the graft to be widely
patent. There is retrograde opacification of the
external iliac arteries and hypogastric arteries
bilateraly. The pigtail catheter was then
manipulated into the right limb of the aortobifemoral
graft then into the SMA bypass graft and injection was
performed. This demonstrated lack of antegrade flow
to the SMA from the bypass graft. There is
complete occlusion of the distal portion of the bypass
graft with lack of opacification of the SMA. The
occlusion appears as an abrupt cut off. An 0.035 glide
wire was attempted to be passed across the level of the
bypass occlusion, however, this was unscccessful. Pt to
be referred to vascular surgery. These are the coding
scenerio's that I came up with. I'm just not sure
which is the most appropriate: 36247, 75625, 75716,
75726 or 36247, 75625, 75716, 75774 or 36247, 75625,
75716 or 36247 and 75630 since the aorta and only the
iliac/femoral vessels were viewed and no S&I code
for the SMA since the graft was totally occluded and
prevented visualization of the SMA? Your help is greatly
appreciated. Thank you.
Dr. Z's Answer: Initially you
performed an aorta and pelvic angio which is
75630. Since you then selected a visceral vessel,
the SMA graft, and you injected and imaged it, you can
code for the selective visceral with 75726 but since
this includes abdominal aortogram, you can no longer
bill 75630 but will need to change that to 75716 only
for the pelvis. So, I would code 36245 for
catheter placement into the graft off the vessel
punctured (continuation of the right common femoral),
75716 and 75726.
The 2006 ZHealth Coding Conference
Schedule
We
had another very successful conference this month
in Orlando, FL--and hope that you can join us at one or
more of ZHealth's interventional radiology and
cardiology coding conferences in 2006:
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Join
Us in Las Vegas
April 25-28
ZHealth
Coding Conference
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