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Cardiology Coding Alert

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3 PTA Coding Scenarios

Published on Tue Jul 01, 2003

If you'd like some practice coding peripheral percutaneous transluminal angioplasties (PTA), take a look at these three scenarios and the coding advice offered by our experts.
 
Scenario 1: The physician catheterizes the left femoral artery. He places the catheter antegrade and injects the left lower extremity artery. He identifies a tight lesion at the left superficial femoral artery (SFA) and performs balloon angioplasty (PTA). Post-PTA imaging shows much improvement.  
  
Coding advice: Report 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal) for the PTA in the left SFA, says Anne C. Karl, RHIA, CCS-P, CPC, coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn. Use 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) for the selective catheterization of the left SFA. For the angiography in the left extremity artery, report 75710-26 (Angiography, extremity, unilateral, radiological supervision and interpretation; Professional component). For the PTA radiological S&I, report 75962-26 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation).
 
Scenario 2: The physician places the catheter in the contralateral internal iliac artery and injects contrast media for a leg study. The internal iliac is occluded. She performs balloon angioplasty.
 
Coding advice: This case is a good example of why physicians need to be specific as to which "iliac" artery they are in, says Terry A. Fletcher, BS, CPC, CCS-P, CCS, CMSCS, a healthcare coding consultant based in Laguna Beach, Calif., and American Academy of Professional Coders National Advisory Board member. The "internal iliac" is considered a "pelvic or hypogastric vessel" (the common iliac and external iliacs are considered extremities), she says. "So your angiography codes are different for the internal iliac." First, you have a second-order selective catheter placement, so you should report CPT 36246, she says. For the pelvic angiography, report 75736-26 (Angiography, pelvic, selective or supraselective, radiological supervision and interpretation). For the iliac PTA, report CPT 35473 (Transluminal balloon angioplasty, percutaneous; iliac). Report 75962-26 for the PTA S&I.
 
Scenario 3: The physician places the catheter in the abdominal aorta and images the renals. The physician then selectively advances the catheter into the right renal artery and performs further angiography. He finds marked stenosis and performs a PTA of the right renal artery.
 
Coding advice: "The first thing I always recommend when coding for peripheral procedures is to code everything indicated in the operative/procedure note," Fletcher says. "Then go over your codes and cross out anything bundled into a code." This scenario is a good example of why you should go back through and reassess your codes, just in case some are bundled, she says. "Our first code would be 75625-26 for the abdominal aortogram, full and complete study, at the level of the renal arteries. Then you would report 75722-26 for the imaging in the selective right renal artery and 36245 for the selective catheter placement in the right renal. For the PTA of the right renal artery, report 35471 ( renal or visceral artery) and for the renal S&I, report 75966-26."
 
But Fletcher cautions that you not are done yet. "When you look at code 75722 or 75724, the S&I for the renals, it says, 'including flush aortography.' This means that when we code the 75722 or 75724, we lose the 75625-26 code, which is included in the value of the selective S&I codes." So the final codes for this scenario should be 35471, 75966-26, 36245, 75722-26, she says.

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