July 2015 Q & A

Question: 2 Infusion Catheters, 2 Graft Punctures for Access of the Same Leg

The patient has a left femoral to below-knee popliteal artery bypass graft and a left abandoned bypass graft. A micropuncture needle was advanced in a midline retrograde fashion and a sheath placed. A pelvic angiogram shows occlusion of the bypass graft and a 10 cm infusion Cragg-McNamara infusion catheter is placed and positioned across the proximal arterial anastomosis. Then under direct ultrasound guidance, a micropuncture needle was advanced into the proximal graft in an antegrade fashion, then a sheath was placed, followed by lower extremity angiography. Next, a 10 cm infusion length Cragg-McNamara catheter was advanced across the distal anastomosis. 1mg TPA per hour split between the 2 infusion catheters with 300 units per hour.

Since there are two separate access sites, can I code 36140*2, 37211*2, and 75716? Please advise, because I am not sure if I can code both since it's the same leg. Although there are two separate access sites and two infusion catheters placed.


Answer:

The retrograde catheter placement code is 36140-59, while the antegrade catheter placement across the distal anastomosis would be a first order selection 36245. Since the extremity is considered the surgical site, I would only submit 37211 once and only a unilateral extremity angiography was done (75710-59).