Cardiology Coding Alert

Plus: Find out whether you should use -50, -RT, -LT and/or  -59 for catheter placement When your cardiologist fails to document specifically whether an angiogram was selective, you could take your best guess at the correct code - but you'd be making a big mistake. Here's the correct way to handle these tricky situations. 1. Locate the Problem's 'Origin' With This Scenario When you receive an op note for an angiogram, you may find one vague word that could potentially throw you off the right track and lead you to an audit situation.

Scenario: Your cardiologist's op notes say the following: "We went up with a  5 French internal mammary (IM) catheter to the origin of the right renal and did an angiogram of that system."

So now you're left holding the bag. Would you consider the angiogram selective, because the cardiologist said "origin," which means the point in which something begins? 2. Look for 'Selective' Terminology Although the cardiologist mentioned the origin of the renal arteries, he gave no indication that there was selective advancement of the IM catheter.

Look for keywords: Your cardiologist has to use one of the "magic words" that allow you to report the selective placement, such as "... the renal artery was selectively engaged ..." or "... the renal artery was cannulated with ...," says Karen Salowitz, RN, CPC, billing coordinator at Heart and Vascular Center in Phoenix. In this case, you only have "to the origin" to work with.

"I wouldn't code this as selective," says Deborah Ovall, CMA, CCS, CIC, lead coder and data quality analyst with Medical College Hospitals of Ohio at Toledo. "To me, 'to the origin' means that the cardiologist is at the entrance but still in the aorta."

You should ask your cardiologist to document clearly whether he actually engaged the renal artery(s) with the catheter and performed a selective renal angiogram. If the study was nonselective, you should report the catheter placement with CPT 36200 (Introduction of catheter, aorta) and the imaging with CPT 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) - codes that are a far cry from those you would use for a selective renal angiogram. In fact, you'll find about a $100 difference between the nonselective and selective renal angiograms, based on national averages. 3. Pinpoint the Proper Way to Bill Selective Renal Angiograms Because you know the importance of reporting the correct procedure, you must ask your cardiologist for more specification. Your questions may have uncovered that this procedure was, in fact, a selective renal angiogram and the only diagnostic study he performed.

The proper way to report this depends to some extent on carrier/payer instructions. "You can code selectively engaged renal arteries in [...]