Ask Dr. Z

I know your newsletter in August talked about this, but it is being interpreted in different ways by various staff so I'm hoping you can give us an answer that can clarify. Patient has a CTA that shows an aneurysm in the right anterior communicating artery. Patient is brought to the cath lab where bilateral intracranial arteries and bilateral vertebral arteries are selected and imaged. Coils are placed into the right ACA, and follow-up imaging is performed. Dictation states, "A full four-vessel diagnostic angiogram is performed due to inadequate visualization of the anatomy and pathology on prior CTA." Findings are presented. This is the physician's standard workflow for all embolization cases. I would code 36224-50, 36226-50, 61624, 75894, 75774. My colleague disagrees with the diagnostic imaging because the CTA diagnosed the aneurysm and the physician has no grounds for repeat diagnostics: no change in status, no surprise findings. How would you code it?