Q & A with Dr. David Zielske
Question     My question concerns how to code for the aortic arch imaging done with upper extremity angio now that CPT 75650 has been deleted and 36221doesn't appear to be correct. Extremity angio done for suspected steal in diabetic patient with RUE AV fistula. Patient presents with numbness/tingling of Rt hand with non healing sore of hand. Access via groin with final catheter placement in the Rt subclavian. Findings: Cervical cerebral arch-bovine type arch anatomy. Origins of the great vessels all patent. Antegrade flow noted in all of the great vessels noted. RUE arteriogram--Widely patent high origin radial artery to cephalic vein fistula above the level of the right elbow with significant AV steal. Only significant flow to hand is via collaterals that fill radial artery at the level of the proximal forearm with sluggish antegrade flow down to hand. Ulnar artery occludes above the level of the wrist. We have 75710with 36215. Thank you.
Answer     I would code the arch with 36221 and the upper extremity with 75710 and 36215 (unless further selected).  You can definitely code the arch and a catheter placement, if the catheter placement is unrelated to vertebral or carotid imaging, which is the case here.

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