Ask Dr. Z

Good Morning Dr Z, once again I need your help in determining the correct way to code/bill this procedure. We coded 93799, 93544, 75774, 36215,75898 and 37204. Can we code 36215 for the selective catheterization for the AP collateral off of the aorta? I attended one of your Webinar's (which was wonderful) and you addressed the issue of collateral catheterization, but I cannot remember just what you said about these when a HC is done. ~thanks Catheterization for PDA occlusion. Procedure Note: A complete right and left heart cardiac catheterization was performed. All the appropriate chambers and vessels were entered, including SVC, RA, RV, MPA, LPA, LV, AAO and DAo. Oxygen saturations and pressure measurements were obtained by standard catheterization technique. After the hemodynamic data was obtained, a pigtail catheter was advanced to the base of the distal aortic arch and a descending aorta gram was performed. The PDA was identified. There was a moderate-sized PDA that tapered to approximately 2mm at the pulmonary artery insertion site. The geometry was suitable for a ductal occluder. We also noticed a very prominant bronchial collateral supplying the right lung which was felt to be hemodynamically significant and also likely require intervention. We then proceeded with the occulsion of the PDA usinga 6-French delivery sheath. By way of the right femoral vein, over a wire, we positioned the delivery sheath in the descending aorta. We loaded a 6/4 ductal occluder in the usual fashion and deployed the device. We then performed an angiogram with the device still attached to the delivery cable. It was in excellent position fo released in the usual fashion. We then turned our attention to the AP collateral. Using a 4-French angled Glidecatheter, we engaged the collateral which was just to the right of the PDA. We then performed select hand injection in the collateral. There was a very prominent collateral that supplied both the right middle and right lower lobes of the right lower lind. Measured 2 mm in diameter. We selected a 2x3 diamond shaped Vortex coild with the microcatheter positiioned deep in the AP collateral we depolyed in the usual fashion, followed by a 3mmX6cm.