Ask Dr. Z

The physician initially attempts a right radial approach and documents that he has difficulty and brings the catheter up to the aortic arch and into the ostia right subclavian and documents that the patient has an anomolous takeoff of the right subclavian off the aortic arch. The doctor then takes a femoral approach and performs a standard left heart cath. No vertebrals were mentioned. I'm thinking 36215-59 (separate takeoff of the right would make this a 1st order, correct?) and a 75710-RT-59 as well as the 93458 for the garden variety LHC and a 93567 as he does discuss the aortic arch but that was after with the LHC approach. I considered 36225 but no vertebrals were mentioned and it didn't seem like this was really the intent of the angiography. I'd really appreciate your thoughts on this. Thank you.