One catheter across two phases

Read an original fictional chart, identify the supported facts, and explain your coding workflow.

Chart gym · Original fictional record

Service date: 2026-09-09 · Medicare respiratory or cardiovascular professional service

Use your code books and write your reasoning before opening the walkthrough. This exercise contains no real patient information.

Procedure context

Synthetic vascular procedure record, September 9, 2026. An adult with left-arm exertional symptoms undergoes non-coronary angiographic evaluation of suspected left subclavian stenosis. Right femoral arterial access is obtained and the catheter is advanced into the left subclavian artery.

Signed catheter timeline

Selective imaging demonstrates a significant left subclavian stenosis, and the operator proceeds to balloon angioplasty of that vessel. The catheter remains in the same vessel during a preparation interval and the treatment. No additional selective placement is performed.

Imaging record

Contrast injections during treatment guide balloon positioning and check the result. They do not investigate another diagnostic question. The report separately describes the initial diagnostic findings and later procedural images; there is no second diagnostic angiogram merely because more images are saved.

Placement worksheet

A draft counts two selective catheter placements, one for diagnosis and one for treatment. Another draft adds an angiogram for every positioning injection. Evaluate these additions under Medicare NCCI. The full current intervention and diagnostic-study rules must still be checked, including any entry that already includes catheterization or imaging.

Your coding worksheet

Count actual documented placements.
Explain the effect of leaving the catheter in place.
Separate diagnostic work from positioning injections.
List the remaining full-entry and angiography-condition checks.

In your notebook, record the supported facts, your index route, the instructions you checked, and any missing detail that limits your answer.

Compare with the worked explanation

One selective placement into the left subclavian artery is documented. The catheter remains there between diagnosis and balloon angioplasty.
NCCI D.12 does not permit a second placement simply because the phases are separated by an interval.
Positioning and completion injections are procedural guidance, not additional independently indicated diagnostic studies.
Check the full current entries for any separately reportable initial diagnostic study, placement and intervention. One placement event does not guarantee a separate catheterization line if the selected comprehensive service includes it.

Reference sections: D.12–13

Practice the linked chart questions