Question:

What would be the code when a physician performs selective angiography of the anterior and posterior superior pancreaticoduodenal artery? I thought it should be 36248 x 1 and 75774 (since the left hepatic was selected first) but have been told to code 36248 x 1 and 75774 x 2, which seems inappropriate.

+36248 Selective catheter placement, arterial system; 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)
75774 Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (S & I) (List separately in addition to code for primary procedure)

Answer:

The anterior and posterior superior pancreaticoduodenal arteries are separate branches that usually arise from the gastroduodenal artery. Normally that would involve catheterization from the aorta to the celiac trunk into the common hepatic artery to the gastroduodenal artery (GDA), then into one of these branches, and then pulling back into the GDA and catheterizing the second branch. It would be appropriate to report two catheterization codes and two S & I codes.

If the left hepatic had already been selected and imaged, then you would report 36248 x 2 and 75774 x 2 for the anterior and posterior superior pancreaticoduodenal arteries (assuming normal anatomy).

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