Abdominal Aortography Interp May Be Payable With Heart Cath
Published on Fri Jun 01, 2001
Additional payment may be obtained for any abdominal aortography performed during the same session as a left heart cath with aortography of the aortic root but only if documentation indicates that the intent of the abdominal aortography was to treat a different problem.
Procedure notes therefore need to document clearly and accurately (by including, for example, a second diagnosis) that the additional aortography was separate from the heart cath.
When a left heart cath is performed, aortography in addition to the more typical angiography of the left coronary chambers and the coronary arteries may be performed to obtain images of the aortic root (where the aorta joins the heart). For this procedure, 93544 (injection procedure during cardiac catheterization; for aortography) is reported with 93556 (imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).
Any images obtained from injections in the ascending aorta (the first section of the aorta, defined as the section from the left ventricle to the arch, or bend) are included in 93544/93556. According to the American College of Cardiologys Guide to CPT Coding, 93544 involves positioning the catheter in the ascending aorta above the aortic valve. It does not, however, describe abdominal aortography.
Abdominal aortography may be performed following a heart cath. For example, the cardiologist may have difficulty passing a guidewire and catheter from the access site (the femoral artery) to the aorta because the patient has tortuous arteries (defined as twisted and full of turns), says Martha Gerant, CPC, a coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan.
If the coronary problem requires urgent attention, Gerant says, the cardiologist may perform the heart cath first. While the catheter is being removed via the aorta, another injection is performed to image the abdominal aorta or other arteries (such as the renal, iliac and femoral arteries).
Abdominal aortography and heart cath may also be performed simultaneously if the patient has an additional problem (such as hip pain or leg cramps) that the cardiologist wants to assess at the same time, Gerant notes.
Even if aortography of the aortic root (or elsewhere in the ascending aorta) has already been performed (and reported using 93544/93556), the supervision and interpretation of the abdominal aortogram (which reflects the manipulation of the catheter as well as the interpretation of the images) should be separately payable using either 75625 (aortography, abdominal, by serialography, radiological supervision and interpretation) if only the aorta is imaged, or 75630 [...]
