Ask Dr. Z

Selective Catheterization of Aortobifemoral Bypass Graft - What is the selective catheter code when documentation states "RIM catheter was used to gain access to the contralateral iliac limb of the aortobifemoral bypass graft. Once we gained access to the bypass graft with the wire into the common femoral artery, this catheter was removed and a 4-French straight catheter was advanced over top of the wire into the proximal limb of the right iliac system. Following this, a right lower extremity run-off arteriogram was performed...". A left arteriogram was performed via the sheath. It is coded as 36246 by the Rad Tech but I don't think this is correct. The catheter was in the aorta first from the left common femoral access. I thought the graft was 1st order off the aorta so is the iliac limb 2nd order???? Also, since left arteriogram was performed via sheath, a catheterization is not coded, correct? These always confuse me!