Q & A with Dr. Z: Subclavian Artery Angiogram/Intervention


by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Question:
Access site left CFA. Catheter was advanced over the wire to the ostium of the left subclavian, selective angiogram was performed. This demonstrated a subtotally occluded left subclavian artery. Using digital subtraction angiography, the distal vessel did fill suggesting some hibernating arterial supply for micro-channels. Balloon was advanced over the wire into the left axillary artery, selective angiogram was performed. This demonstrated excellent flow to the arm.

The balloon was then pulled back into the left subclavian artery, selective angiogram was performed. This demonstrated no significant flow into the vertebral. The IVUS catheter was then inserted and a pullback was performed. This demonstrated an axillary artery size of 7mm. The left subclavian measured 6.5 x 7.3 mm with a 100% stenosis. Subclavian artery was then ballooned. It was inflated to 14 atm for 20 seconds. Following this the lesion was then stented using a 6 x 40 mm Omnilink stent. It was deployed at 18 atm for 30 seconds.

Do I code 36225-LT, 37236, 37252 OR 75710-LT, 37236, 37252?

Answer:
Report the upper extremity angiography 75710 along with catheter placement 36215, IVUS 37252 and stent placement 37236 (not a vertebral angiogram).

 

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About the Author

David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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