abdominal aortic angiography

this is what was dictated, but what can I bill for?

1 Selective coronary angiography with intention for left ventriculography

2 Right common femoral artery angiography

3 Abdominal aortic angiography with visualization of the abdominal aortic aneurysm

After informed consent was obtained, the patient was brought to the cardiac catheterization laboratory, prepped and draped in the usual sterile manner. A total of 10ml of 1 percent lidocaine were injected into the subcutaneous tissues anterior to this vessel. Next, a Cook needle was passed into the right common femoral artery and after return of blood, a wire was passed through the needle. The needle was withdrawn and then a 6-French side-arm sheath was advanced and positioned in this artery. There was some difficulty in passing the wire up a tortuous and heavily calcified right common femoral artery and iliac arteries so we performed a right common femoral artery selective angiogram to visualize the tortuous vessel. This was followed by passage of an angled glide wire up into the ascending aorta at which point we identified a large dilation of the descending thoracic aorta, consistent with a large aneurysm of the descending thoracic aorta. We spent a short period of time attempting to manipulate a JL4 diagnostic catheter with the glide wire up into the descending thoracic aorta without success and felt based on the angiographic apearance of the aorta and the descending thoracic aorta there did not appear to be a clearly defined lumen to allow for passage of a wire catheter safely up the coronary artery.
IMPRESSION: Based on the patient's difficult to access renal aorta and inablility to easily pass a catheter up to the level of the coronary arteries, the patient's heavy calcification, renal insufficiency, we elected not to proceed with any further evaluation of his coronary arteries including brachial access due to the heavy dense calcification of the aorta and large abdominal aortic aneurysm which appears to be nearly identified and has risk of potential rupture. I would recommend instead proceeding with possible CT angiogram of the coronary arteries if necessary as well as consideration of a chest CT scan, abdominal CT scan to evaluate the aorta throughout the chest and abdomnal cavity to assess for occlusion as well as calcification and tortuosity and aneyrysmal size of these vessels.
Can I bill 93454, 75625? Because the patient is a Medicare recipient should I change the 75625 to G0278?

re: abdominal aortic angiography

its real nice to know that if you need help there is somewhere to go for answers.
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