SAMPLE EDITION PELVIC AND LOWER EXTREMITY ARTERIES WITH ENDOVASCULAR REVASCULARIZATION. Cardiovascular Illustrations and Guidelines

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1 Cardiovascular Illustrations and Guidelines PELVIC AND LOWER EXTREMITY ARTERIES WITH ENDOVASCULAR REVASCULARIZATION ANGIOPLASTY INTRAVASCULAR STENT PLACEMENT ATHERECTOMY For Fem-Pop Territory Angioplasty only Atherectomy with or without angioplasty angioplasty Atherectomy and stent with or without angioplasty Common femoral Profunda femoris Lateral circumflex Perforating branches Lateral descending Superficial femoral Popliteal Geniculate Popliteal Aorta Common iliac Internal iliac External iliac Middle sacral Common tibio-peroneal trunk Anterior tibial Peroneal Posterior tibial For Iliac Territory Angioplasty only (primary) *Add-on angioplasty (primary) *Add-on Atherectomy only 0238T For Tib-Peroneal Territory Angioplasty only (primary) *Add-on Atherectomy with or without angioplasty (primary) *Add-on angioplasty (primary) *Add-on Atherectomy and stent with or without angioplasty (primary) *Add-on

2 Thoracic aortogram (multiple images) common carotids (catheter in both common carotids (all from aortic injection) aorta) (from arch injection), right unilateral common carotid (catheter in common carotid) common carotids) bilateral cerebral carotids (patient has bovine arch, catheter in both Unilateral left vertebral carotids and left vertebral. Patient has bovine arch.) Unilateral right vertebral carotids and right vertebral. Patient has bovine arch.) Bilateral vertebrals carotids and both vertebrals. Patient has bovine arch.) cerebral carotids in both internal carotids) , 9 1, 5, , 5, , 2, , 2, 9 5, 9 1, 5, 6,

3 unilateral left vertebral (patient has bovine arch, catheters in both internal carotids and left vertebral) unilateral right vertebral in both internal carotids and right vertebral) bilateral vertebrals in both internal carotids and both vertebrals) both internal carotids), four vessels (bilateral common carotids, bilateral vertebrals) (all, four vessels (bilateral common carotids, bilateral vertebrals), left vertebral is reflux filled with catheter in subclavian (catheter in left subclavian, left common carotid, right common carotid and right vertebral) bilateral vertebrals, bilateral internals (catheter in both common carotids and both vertebrals) unilateral left or right vertebral (all commons, unilateral right vertebral; right vertebral is reflux-filled via a subclavian injection (catheter in both only (catheter in both Bilateral common and bilateral cerebral carotids (catheter in both Unilateral common carotid and cerebral carotid (catheter in common carotid), right or left side Left Selective Right Coding Tip References 1, 5, 6, 9 1, 5, 9,12 1, 5, 6, 9, 11, 12 1, 5, 6, 9, 12 1, 5, 1, 5, 9, 11 1, 9 1, 9 6, 9 103

4 Unilateral common carotid and cerebral carotid (final placement of catheter is in internal carotid), right or left side (final placement of catheter is in each internal carotid) Bilateral vertebrals (all Bilateral vertebrals (final catheter placements in both vertebrals and both internal carotids) Unilateral left or right vertebral (all common carotids Unilateral left vertebral (selective of both commons, selective left vertebral, vertebral arises directly from aorta) Right common carotid, right vertebral, right internal mammary, right thyrocervical and right costocervical arteries (all selective via a right or left groin approach) Right common carotid, right vertebral, right internal mammary, right thyrocervical and right costocervical arteries (all selective via a right brachial approach) Bilateral selective internal carotids, posterior communicating and middle cerebral arteriograms via a femoral approach (all Bilateral selective internal carotids, posterior communicating and middle cerebral arteriograms via bilateral common carotid punctures (all Unilateral common carotid via direct stick and injection of left or right (ipsilateral) common carotid 6, (x4) (x4) 1, 6, 9 1, 1, 6, 1, 1, 4, 5, 9, 12 8,, 13 8,, 13 1, 6, 7, 8, 9 1, 6, 7, 8, 9 5, 9 104

5 Unilateral selective left internal carotid injection via direct stick of left common carotid Unilateral selective right internal carotid injection via direct stick of right common carotid Unilateral left common carotid bifurcation angiogram only via left carotid stick and injection Unilateral right common carotid bifurcation angiogram only via right carotid stick and injection Unilateral left common and cerebral carotids via direct stick and injection of left common carotid Unilateral right common and cerebral carotids via direct stick and injection of right common carotid 6, 9 6, 9 5, 9 5, 9 6, 9 6, 9 HEAD, NECK AND CHEST ANGIOGRAPHIC RADIOLOGY CODING TIPS 1. Imaging of the carotid and vertebral arteries from a non-selective aortic injection/catheterization is included in Code does not replace true imaging of the thoracic aorta (CPT or 75605) or the abdominal aorta (CPT or 75630). If separate and complete diagnostic studies are requested and performed of the arch and thoracic and/or abdominal areas, each should be charged/coded. It is strongly recommended that separate paragraphs be contained in the final narrative report to support/substantiate each study. If multiple anatomic areas are studied from a single vascular access point, do not additionally assign with Anatomic variants (i.e., bovine arch, common left common and right innominate origin, left vertebral origin off of arch, aberrant right subclavian origin) do not change code assignment. 4. Selective head and neck codes include imaging of the arch if performed. Do not also code Selective intracranial carotid imaging codes and include imaging of the extracranial carotids (common carotid, proximal internal carotid, and non-selective external carotid) if performed. Do not also code. 6. Add-on code can only be assigned if the external carotid artery or any of its branches are selected. Code must be assigned in conjunction with,, or. This code is inclusive of any/all additional selective studies of ipsilateral external carotid artery branches. 105