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Arch Angiography

Date: May 21, 2014

Question:

"Right femoral artery was accessed with Microvena puncture kit. A 5 French sheath was placed. Angled pigtail was then advanced over the 0.035 wire and positioned in the aortic arch. Aortic arch angiography was performed. A JR4 catheter was then advanced over a 0.035 guidewire and engaged into the left subclavian. Left subclavian and left upper extremity angiography was then performed. The JR4 catheter was then directed up the right innominate, and the right upper extremity angiography was then performed. Catheter was then removed. A 6 French AngioSeal was then used to obtain hemostasis. Arch Angiography: There is a widely patent right innominate, proximal right common carotid artery, normal left common carotid artery and left subclavian. Left Upper Extremity: No significant stenosis in the left subclavian artery and left upper extremity extending to the wrist. Right Upper Extremity: Right subclavian, axillary, brachial, and ulnar arteries are normal."  I reported codes 36215 and 36215-59; however, the facility thinks code 36221 is more appropriate. What are your thoughts?

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