Coding IR Example-Aortogram and bilateral lower extremity angiogram

Procedures performed: Aortogram, Selective bilateral lower extremity angiography.

Indications for procedure: A 53-year-old patient with HTN, hyperlipidemia, DM II and leg pain that comes for arteriogram evaluation.

Procedure: After informed consent, the patient was brought, prepped and draped in the usual fashion. Under sterile conditions and local anesthesia percutaneous access was obtained using a 4F introducer in the left femoral artery using the modified Seldinger technique. A total of 80 ml of contrast was utilized during the procedure. Catheter was placed suprarenal, dye was injected and aortogram was obtained. And, the catheter was pulled back and kept at the aortic bifurcation, dye injected, bilateral pelvic angiograms were performed by power injector using a 4F pigtail catheter that was advanced with the help of 0.035 inch Terumo wire. Then, the catheter was advanced contra-lateral into the superficial femoral artery with the help of wire. Selective angiography of the lower extremity was performed. Finally, the catheter was pulled out and ipsilateral lower extremity angiography was performed through the artery introducer.

Abdominal aorta-iliac & pelvic arteriogram: The infra-renal abdominal aorta and the renal arteries are patent. The common, internal and external iliac arteries have minimal irregularities. The distal left common iliac artery has 75% stenosis. The left internal and external iliac arteries have minimal irregularities.

Left lower extremity arteriogram: The common & deep femoral and popliteal arteries have non-obstructive plaques. The proximal and distal superficial femoral artery has heavily calcified 75% to 85% lesions. The proximal anterior and posterior tibial arteries are occluded. The rest of the tibioperoneal arteries and branches are patent.

Right lower extremity arteriogram: The common & deep femoral and popliteal arteries have non-obstructive plaques. The mid SFA has a heavily calcified occlusion reconstitute by bridge collaterals. The proximal anterior tibial artery is occluded. The rest of the tibioperoneal arteries and branches are patent.

Impression: Obstructive peripheral arterial disease (PAD).

Codes:

ICD-9-CM: 440.20, 401.9, 272.4, 250.00

CPT: 36247, 75716 and 75774.

Hints: Ipsilateral pull back injections are not coded with 75774 as 75774 is a selective angiography code.