AMA Clinical Examples in Radiology - 2013 Issue 2 (Spring)
Bilateral Upper Extremity Angiography
Bilateral Upper Extremity Angiography Clinical History 28-year-old patient with history of bilateral upper extremity degloving injuries status post motor vehicle accident. Patient presents for bilateral upper extremity angiography for preoperative planning prior to flap reconstruction. Procedure Diagnostic angiography of bilateral upper extremity. Technique 99144 99145 x4 Moderate sedation was administered under the attending physician's direction, and continuous monitoring was performed by a trained nurse specialist who was independent from those actually performing the procedure. Total monitored sedation time was 95 minutes. The risks, benefits, and alternatives were discussed with the patient and informed consent was obtained. Prior to beginning...
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Article Overview
This clinical example explains how a bilateral upper extremity angiography case is coded and documented in a radiology setting. It covers procedural elements such as selective catheter placement, thoracic aortic imaging, bilateral extremity angiography, moderate sedation time, and related quality-reporting documentation. The article is useful for coders, radiology practices, and compliance staff reviewing CPT and Category II reporting for vascular imaging studies.
Why This Topic Matters
Upper extremity angiography cases often involve multiple imaging and catheterization components, plus separate documentation requirements for sedation and fluoroscopy-related reporting. Understanding how the case is described helps support accurate coding review and complete radiology reporting.
Article Sections
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Clinical History
Introduces the patient context and the reason the vascular imaging study was performed.
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Procedure
Summarizes the diagnostic angiography service and the procedural setting in broad terms.
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Technique
Describes the access approach, catheterization sequence, and imaging workflow used during the study.
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Findings
Presents the angiographic observations from the thoracic and upper extremity vessels.
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Impression
Provides the overall interpretive summary of the vascular findings and incidental observations.
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How to Code
Explains the coding framework discussed in the case, including procedural reporting, sedation, and quality measure documentation.
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Discussion
Reviews the coding rationale, documentation considerations, and related CPT and PQRS reporting context.
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References
Lists source materials cited by the article.
What You Will Learn
- How a bilateral upper extremity angiography case is organized for coding review
- What procedural components are documented in a vascular imaging example
- How sedation and fluoroscopy documentation are discussed in a radiology coding context
- How the article frames related CPT and quality-reporting considerations
Who Should Read This
- Medical coders
- Radiology coding specialists
- Compliance staff
- Revenue cycle professionals
- Radiologists
- CPC/CCS credentialed professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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