# Help with angioplasty/angiography rules



## jtb57chevy (Feb 10, 2010)

I remain confused about when it is appropriate to bill for an angiography during a angioplasty+/or stent procedure. I learned the "basics" from a local IR coder and this person always billed an angio with either stent or PTA. However, I recently purchased the CIRCC study guide(would like to sit for the exam one day in the distant future) and, according to it, followup angios should not be billed unless there is medical necessity.

I'd appreciate any information, clarification, explanation anyone could give, so I can be confident of these procedures.

Here's an example:

 After having informed consent obtained, the patient was brought to the catheterization suite in a fasting state.  The patient's left groin was prepped and draped in normal sterile technique.  The left groin area was anesthetized using 1% Lidocaine.  Using a Mini Stick kit, the left common femoral artery was accessed and with an antegrade access stick, an exchange to a 6 French Arrow catheter was performed.  PTA was performed using a 4 x 40 Powerflex to 10 bars. An exchange to a 7 French short Arrow sheath was then performed and cryo balloon PTA was performed in the distal and mid aspects of the blood vessel using a 6 x 40 Cryo balloon x 2 inflations in each segment.  Following this, the patient had excellent angiographic results with reduction of the stenosis to less than 10% in each of these lesions with very significantly improved blood flow to the distal aspect of his foot.  The patient was to have a Syvek used to help facilitate hemostasis.  

My current code selection is 35474, 36245 and 75962-26.

Thanks for any and all help


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## mikereyland (Feb 10, 2010)

The book is correct….follow-up angiograms are not separately reportable unless of course medically necessary.  Only the diagnostic angiogram should be reported and with a 59 modifier if an intervention is done.  Also Road-map angiograms are not separately reportable.
In this example there is not enough documentation to report 36245, for that the catheter needs to access the opposite leg, the Common Iliac of the same leg, or SFA or lower of the same leg.  According to the dictation the catheter came into the Common Fem. and an angioplasty was done of that artery. I would code 36140. Hope that helps.

Michael D. Reyland, CPC, CIRCC
Surgical Specialists of Georgia


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## Jim Pawloski (Feb 20, 2010)

mikereyland said:


> The book is correct….follow-up angiograms are not separately reportable unless of course medically necessary.  Only the diagnostic angiogram should be reported and with a 59 modifier if an intervention is done.  Also Road-map angiograms are not separately reportable.
> In this example there is not enough documentation to report 36245, for that the catheter needs to access the opposite leg, the Common Iliac of the same leg, or SFA or lower of the same leg.  According to the dictation the catheter came into the Common Fem. and an angioplasty was done of that artery. I would code 36140. Hope that helps.
> 
> Michael D. Reyland, CPC, CIRCC
> Surgical Specialists of Georgia



Hi Mike,
I agree with you in your 36140, but if the intervention was done in the SFA on an antegrade stick, would you then bill 36245 for the catheter placement?
Thanks,
Jim Pawloski CIRCC
National Healthcare Review, Inc


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## Anug123 (Feb 22, 2010)

It should be 36245 for SFA, and predilatation and postdilatation for stent shouldn't be coded.  Follow-up, roadmapping, images for localization shouldn't be coded for angioplasty.

Hope this helps

Prabhavathi


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## mikereyland (Feb 24, 2010)

Jim Pawloski said:


> Hi Mike,
> I agree with you in your 36140, but if the intervention was done in the SFA on an antegrade stick, would you then bill 36245 for the catheter placement?
> Thanks,
> Jim Pawloski CIRCC
> National Healthcare Review, Inc



Hey Jim,
Yes, an antegrade stick into the Com. Fem and the cath. advanced to the SFA 36245 is appropriate.

Michael D. Reyland, CPC, CIRCC
Surgical Specialists of Georgia


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