# Spinal angio help needed



## kparkhurst

Can anyone point me in the direction of some coding resources for spinal angios? I am auditing a neurosurgery practice and this is the first spinal angio I have encountered. I am at a loss as to where to begin. Any direction would be appreciated!!!


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## kbazarte@yahoo.com

below is from Z-Health, I HIGHLY recommend getting the Z-Health Coding refernce books I refer to mine as the Z-Bible 

PROCEDURE:

Spinal angiography involves catheter placement into paired spinal arteries (intercostal above and lumbar below the diaphragm) with injection of contrast and imaging of the blood flow to the spine or spinal cord. This may also include injection of supreme intercostal, subclavian, thyrocervical, vertebral, internal iliac, and median sacral arteries. 

CLINICAL INDICATIONS:

Evaluation for subarachnoid hemorrhage related to possible spinal arteriovenous malformation (AVM) or abnormal MRI suggesting spinal AVM. Evaluation of blood supply to primary or metastatic tumors of the vertebral bodies. Abnormal findings may be followed by an embolization procedure. 

CODES:


PROCEDURE DESCRIPTION	PROC CODE	APC	TOTAL RVU	S&I CODE	APC	TOTAL RVU

Spinal angiography, per vessel (selective), if supplying spinal structure	 	 	 	75705	0279	3.19

Spinal angiography, per vessel (selective), if supplying bronchial structure	 	 	 	75726	0279 	1.69

Internal iliac angiography (selective)	 	 	 	75736	0279	1.67

Median sacral angiography (selective), if supplying spinal structure	 	 	 	75705	0279	3.19

Median sacral angiography (selective), if supplying pelvic structure	 	 	 	75736	0279	1.67

Subclavian angiography	 	 	 	75710	0279	1.66

Costovertebral trunk angiography (following subclavian)  (additional vessel, selective, after basic exam)	 	 	 	¶*75774	N/A	0.54

Supreme intercostal angiography (after selective catheter  placement into the vessel), if supplying spinal structure	 	 	 	75705	0279	3.19

Supreme intercostal angiography (after selective catheter  placement into the vessel), if supplying bronchial structure	 	 	 	75726	0279	1.69

Thyrocervical trunk angiography (following subclavian)  (additional vessel, selective, after basic exam)	 	 	 	¶*75774	N/A	0.54

Internal mammary angiography	 	 	 	75756	0668	1.90

Catheter placement, 1st order selective above diaphragm	36215	N/A	7.54	 	 	 

Catheter placement, 2nd order selective above diaphragm	36216	N/A	8.53	 	 	 

Catheter placement, 3rd order selective above diaphragm	36217	N/A	10.15	 	 	 

Catheter placement, 1st order selective below diaphragm	36245	N/A	7.69	 	 	 

Catheter placement, 2nd order selective below diaphragm	36246	N/A	8.47	 	 	 


¶*Add-on Code 

CODING INSTRUCTIONS:

1. Spinal angiography (75705) requires selective catheter placement into the vessel to use this code. 

2. Not all spinal (intercostal, lumbar) arteries are injected, as there is often collateralization to adjacent levels present. 

3. Embolization may be performed for treatment of spinal cord lesions (61624) or vertebral body lesions (37204). 

4. There may be a combined bronchial-intercostal trunk off the thoracic aorta on the right side. The ascending cervical artery to the spinal cord arises off the right bronchial artery, requiring more selective catheterization for imaging and embolization. This imaging is coded 75705, as it is a spinal angiogram. If performed, the initial bronchial angiography is coded with 75726. 

5. Code 75705 is a unilateral code. Use this code twice if procedure is done bilaterally (75705 & 75705-59). This code may be used 20-30 times appropriately. Do not expect payment for every one of these imaging procedures when the number of repeated codes is this high. 

6. Do not use a combination -5950 modifier for multiple above diaphragm bilateral catheter placements. The -50 modifier should not be used after October 2005 for bilateral above diaphragm catheter placement codes. Bill the codes with multiple service units and -59 modifier. 

7. The supreme (superior or "highest") intercostal artery is a 3rd order selective branch off the costocervical trunk (which originates as the third branch directed in a cephalad direction off both the right and left subclavian arteries, transfemoral approach). 

8. If intent is to image for spinal abnormality, use code 75705 when injecting the intercostal artery. If intent is to image for bronchial bleeding or other bronchial abnormality, use code 75726 when injecting the intercostal artery. 

9. The middle or median sacral artery is considered a spinal artery (75705), if injected to evaluate the sacrum for neurologic abnormalities. If injected to image a pelvic mass (e.g., bladder tumor), use code 75736. 

10. Internal mammary angiography (75756) cannot be billed during cardiac catheterization procedures due to NCCI edits (zero edit). 

EXAMPLE(S):

1) Patient presents with subarachnoid hemorrhage and abnormal MRI suggesting spinal cord arteriovenous malformation (AVM). Thoracic (75605) and abdominal (75625) aortograms are performed, followed by selective catheterization and imaging of T5-T12 intercostal arteries bilaterally (36215-59 x 16, 75705, 75705-59 x 15), L1-L5 spinal arteries bilaterally (36245-59 x 10, 75705-59 x 10), both subclavian arteries (75716), both internal mammary arteries (75756, 75756-59), both supreme intercostals (75705-59 x 2), the median sacral (36245-59, 75705-59), and both internal iliac arteries (75736, 75736-59, 36245-59, 36246). The patient requires embolization of two vessels (61624, 75894, note: this is one surgical site), and two post embolization follow-up exams (75898, 75898-59). The catheter placement codes for the work related to imaging from the subclavian, internal mammary, and supreme intercostal arteries are 36217 and 36218 on the left and 36217-59, 36218 on the right. 

The case detailed above is likely one of the more complicated cases you will code - 73 CPT codes during one session! 

Note: Do not necessarily expect payment for all these codes; however, all described catheter placements and imaging are appropriate to code and charge. Use a -59 modifier, as needed, to distinguish separate and distinct procedures (particularly for codes 75705, 75756, 75736, and catheter placements). Do not use a -50 modifier on codes 36215, 36216, or 36217. 

REFERENCES:

CMS Modifier -59 Article, Oct 2005, http://www.CMS.hhs.gov/NationalCorrectCodInitEd/Downloads/Modifier59.pdf 

CPT Assistant Fall 93:11, Aug 96:3, Apr 99:7 (Topic 1, Topic 2), Oct 00:4, Jan 01:11 

SIR Interventional Radiology Coding Users' Guide 2009 pages 48-52


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## kparkhurst

Thanks so much - this helps tremendously!!!


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