Interventional Radiology Coding Basics. PRESENTED BY:. Rosemary Waligorski, RHIT, CCS, RCC CHW IVR/CVIR Coding Compliance Spec . NvHIMA State Meeting April 24, 2010. Objectives and Goals. Basic understanding of interventional radiology Gain knowledge of key terms and phrases
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Rosemary Waligorski, RHIT, CCS, RCC
CHW IVR/CVIR Coding Compliance Spec
NvHIMA State Meeting
April 24, 2010
Interventional radiology is the non-surgical treatment using radiologic imaging, with contrast, to guide instruments (catheters, balloons, etc) through the body’s blood vessels and other organs. This type of procedure is done for both diagnostic and therapeutic procedures and is usually done on an outpatient basis.
Some common types of procedures done in interventional radiology include:
36120 Introduction of needle or intracatheter; retrograde brachial artery
36140 extremity artery
36200 Introduction of catheter, aorta
36215 Selective catheter placement arterial system: each first order thoracic or brachiocephalic branch, within a vascular family
36216 initial second order thoracic or brachiocephalic branch, withina vascular family
36217 initial third order or more selective thoracic or brachiocephalic branch, within a vascular family
+36218 additional second order, third order and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)
36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
36246 initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
36247 initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family
+36248 additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate)
75605 Aortography, thoracic, by serialography, radiological supervision & interpretation
75625 Aortography, abdominal, serialography, radiological supervision and interpretation
75630 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation
75650 Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation
75660 Angiography, external carotid, unilateral, selective, radiological supervision and interpretation
75662 Angiography external carotid, bilateral, selective radiological supervision and interpretation
75665 Angiography, carotid cerebral, unilateral, radiological supervision and interpretation
75671 Angiography carotid cerebral, bilateral, radiological supervision and interpretation
75676 Angiography, carotid, cervical, unilateral, radiological supervision and interpretation
75680 Angiography, carotid, cervical bilateral, radiological supervision and interpretation
75685 Angiography, vertebral, cervical, and/or intracranial, radiological supervision and interpretation
75705 Angiography, spinal, selective, radiological supervision and interpretation
75710 Angiography, extremity, unilateral, radiological supervision and interpretation
75716 Angiography, extremity, bilateral, radiological supervision and interpretation
75722 Angiography, renal, unilateral, selective (including flush aortogram, radiological supervision and interpretation)
75724 Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision and interpretation
75726 Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation
75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation
+75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure
Catheter placement in aorta for bilateral renal artery and abdominal aortogram
Catheter placed in aorta and bilateral renal arteries for angiograms
4.Catheter placed in aorta for abdominal aortogram. Catheter then placed in the celiac trunk, inferior mesenteric artery, and superior mesenteric artery; contrast injected and images taken.Case Examples (Abdominal Aorta & Visceral)
Left femoral artery accessed, catheter threaded up, over the abdominal aorta into the common iliac artery, contrast injected for angiography of the right lower extremity.
Left femoral artery accessed; catheter threaded up into the aorta and placed at the bifurcation contrast injected for bilateral lower extremity angiography
Femoral artery accessed. Catheter placed in contralateral common femoral artery for lower extremity angio. Catheter then pulled back to ipsilateral common iliac and contrast injected for lower extremity angioCase Examples (Lower Extremity)
Catheter placed in the right brachiocephalic artery and the left subclavian artery. Upper extremity angiography performed
Access in the right retrograde brachial artery. Upper extremity angio performed.
Access in the right brachial artery for upper extremity angiography. Catheter then threaded up, into, and over the aortic arch and into the left subclavian for upper extremity angiography.Case Examples (Upper Extremity)
Catheter placed in the aortic arch. Contrast is injected and angiography is taken of the bilateral common carotids and bilateral internal carotids.
Same as number 14 with the addition of the external carotid arteriesCase Examples (Head & Neck)
Catheter placed in the right vertebral, right internal carotid, left internal carotid for angiography. Catheter placed in the left subclavian for angio of left vertebral.
Catheter placed in the bilateral common carotid arteries for angiography. Then the catheter was placed in the bilateral external and internal carotid arteries for angiography.
Catheter placed in: right vertebral, right external & internal carotids, left internal and external carotids, and left vertebral arteries where imaging of all these vessels were done and images reported.Case Examples (Head & Neck cont)
20. Local anesthesia provided to patient before procedure began. Right common femoral artery was prepped and draped in a sterile fashion then accessed with small nick incision. Multiple attempts were made to advance the wire and catheter but because of the occluded right external iliac artery, catheters were withdrawn and attention turned to the left groin. Using the same technique as the right groin, access into the left femoral artery was obtained. Catheter was then threaded up into the abdominal aorta to the level of the renal arteries.
Aortography was performed with run-off down to the bilateral common femorals
Images were obtained, after which all catheters were withdrawn and hemostasis obtained through manual pressure.
21. From R groin access, an abdominal aortogram is performed via cath placement in the abdominal aorta and injection above the renal arteries w/ findings documented followed by BLE angiography via cath movement to the bifurcation and injection revealing an abnormality of the R popliteal artery. The catheter is “pulled back” into the R femoral artery and additional injection or imaging is performed of the popliteal artery.
22. Utilizing Seldinger technique and 1% Xylocaine for local anesthesia, a #5 French pigtail catheter was inserted via the right common femoral artery and advanced into the aortic arch where arch aortography was performed. Bilateral carotid arteriograms and bilateral vertebral arteriograms were performed after selective catheterization. The following catheters were utilized: JB2 in the right common carotid, Simmons I in the left common carotid, and a #5 French vertebral catheter in both vertebral arteries. The catheters were removed and hemostasis obtained. The patient tolerated the procedure well. There were no apparent complications (cont)
36245, 36245, 75724
36215, 36215, 36215, 75726, 75726, 75726
36215, 36215, 75716
36200, 75680, 75671
36200, 75680, 75671
36217, 36216, 36216, 75671, 75685, 75685
36217, 36218, 36216, 36215, 75671, 75685, 75685
36217, 36218, 36216, 36218, 75680, 75671, 75662
36217, 36218, 36218, 36216, 36218, 36216, 75662, 75671, 75680, 75685, 75685
36140, 36200, 75630
36200, 75625, 75716
36217, 36218, 36215, 36216, 75650, 75671, 75680, 75685, 75685Answers to Case Examples