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AHA Coding Clinic® for HCPCS - 2010 Issue 3; ASK the EDITOR

Vascular Catheterization

Our coding staff would like clarification of coding advice regarding the appropriate reporting of vascular catherizations which state, “If more than one vascular family is catheterized, then it would be appropriate to code to the highest order vessel catheterized within each vascular family and that modifier 59 would be appended to identify the catherizations of vessels in different families as distinct”. Is this advice valid? Can you take a look at the operative note below and provide guidance? A patient presents with a recent history of transient ischemic attack (TIA), manifested by right upper arm pain, numbness, and weakness. Previous testing demonstrated a possible aneurysm of the distal right internal carotid artery. The patient presents today for further evaluation and workup of atherosclerotic disease and intracranial aneurysm. The details of the procedure are as follows: “Utilizing Seldinger technique and 1 percent 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 catheters were removed and hemostasis obtained. The patient tolerated the procedure well. There were no apparent complications”. What are the correct codes for this case? ...

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