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Date: Apr 15, 2010

Question:

Patient with a traumatic CCF had a diagnostic angiogram and treatment. Physician selects bilateral CCA, ECA, ICA and bilateral Vertebral with imaging.Giant The common carotid arteries are normal bilaterally. The right CC fistula is seen with poor flow intracranially. The left intracranial circulation is unremarkable. Both vertebral imaging procedures and external carotid imaging demonstrate lack of supply to the fistula and normal anatomy. RICA was selected and sacrificed with detachable coils. A follow up angiogram was performed in the RICA demonstrating complete occlusion and no further connection with the CCF. The LICA was selected again and an angiogram was performed demonstrating ACA and MCA arterial distributions. The ACOM appears robust and the right A1 and the right MCA artery show good flow. The right vertebral artery was selected again and an angiogram was performed demonstrating a patent right PCOM with flow seen in the MCA and ICA terminus. There is slow flow seen beyond the supraclinoid portion of the RICA in retrograde fashion to the coil mass. Can I code for the second catheter placement in the LICA and Right Vertebral. Can I also charge for 75898 x3?

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