Ask Dr. Z

I have the following clinical indication and need to know if another diagnostic cerebral angio is coded with procedure, as they are still looking for the source of the SAH. "CLINICAL INDICATION: 65-year-old woman with sudden onset of headache and mild confusion found to have subarachnoid hemorrhage on CT. CTA negative for aneurysm patient is Fisher grade 3 Hunt and Hess grade 3. First angiogram negative. Second angiogram performed 5 days later revealed a small submillimeter aneurysmal lesion at the ventral aspect of the supraclinoid left internal carotid artery, possibly representing a hypophyseal infundibulum, but given the lack of source of bleed, and the suspicious bleed pattern in the head with a left-sided predominance, discussion with neurosurgery yielded an opinion that this should be treated as the source of the patient's subarachnoid hemorrhage, with no other lesion noted. A full cerebral angiogram will be performed prior to treatment."