Thoracic Aortogram with Cerebral Angiography
History: The patient is an 82-year-old man with a thoracic aneurysm and carotid stenosis.
Procedure: A 20-minute consultation was utilized explaining the risks, benefits, and alternatives of angiography. All the patient's questions were answered, and he had given informed consent prior to the procedure. The patient was premedicated with IM Demerol and Phenergan. Buffered lidocaine was used for local anesthesia. Sedation was not required.
A 5-French pigtail catheter was advanced into the aorta via the right femoral artery with the standard Seldinger technique. With the tip of the catheter in the ascending aorta, an aortogram with digital subtraction technique was obtained in the left anterior projection. AP frontal view of the intracranial circulation was also obtained from an arch injection. The catheter was then exchanged over a guidewire for a 5-French Simmons II catheter. The carotid artery and left vertebral artery were selectively catheterized and injected with contrast for digital subtraction filming. In the right common carotid, it was initially difficult to get a stable catheter position, and various combinations of guidewires and a Simmons III catheter were used to obtain selective catheterization. After all images were reviewed, the catheter was removed, and direct pressure was applied to the puncture site until complete hemostasis was achieved.
Total contrast load was 132 cc of Isovue. Fluoroscopy time was 41.5 minutes.
Findings: The ascending aortic arch is dilated and has a more normal diameter just after the left subclavian catheter, and then the descending thoracic aorta enlarges again. There is no evidence of intimal dissection. The origins from the arch are patent. The right carotid bifurcation is slightly irregular; however, no hemodynamically significant stenosis is observed in the right internal carotid. The right external carotid is open. The left external carotid is completely occluded. The left internal carotid has 75% reduction of its cross-sectional area near its origin. On selective injections, it is interesting to note that the right anterior cerebral artery does not fill from the right carotid injection, but both anterior cerebral arteries fill from the left carotid injection. Vertebral arteries are patent. The left vertebral artery is larger. No obvious intracranial abnormality is observed.
Impression: There is 75% stenosis of the left internal carotid. Complete occlusion of the left external carotid. Very mild irregularity of the right internal carotid. Widely patent right external carotid. Both vertebral arteries are patent.
Select the appropriate ICD-10-CM codes.
A) I65.22, I71.1
B) I65.22, I71.3
C) I65.22, I71.2
D) I65.22, I71.4

The Diagnostic Statement "Goiter, Nodular Nontoxic" Would Be Coded as an Unspecified

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