Cardiology Coding Alert

Choosing the proper endovascular abdominal aortic aneurysm (AAA) repair code isn't the end of the coding story for these procedures. Use the tips below to identify all separately reportable services, including radiologic supervision and interpretation (S&I), catheterization, and others.

You should not report balloon angioplasty or stent deployment within the target treatment zone along with primary AAA endovascular repair codes 34800-34805,according to CPT guidelines. The cardiologist may use angioplasty to inflate, and a stent to help anchor, the prosthesis after placing it, for example. The AMA has designed 34800-34805 to include these services.

But CPT guidelines confirm that when the cardiologist must perform interventional procedures in a separate area, you may report them as distinct from the AAA repair.

As examples, CPT guidelines indicate these include:

• Renal transluminal angioplasty

• Arterial embolization

• Intravascular ultrasound

• Balloon angioplasty or stenting of native artery(s) outside the endoprosthesis target zone.

You will have to append modifier 59 (Distinct procedural service) to show the payer that the procedure is not a part of the primary service, and the cardiologist's documentation will have to substantiate that the service occurred at an area distinct and separate from the AAA repair.

If the physician introduces a catheter(s) into the aorta,you may report the placement separately using 36200 (Introduction of catheter, aorta). "Introduction of guidewires and catheters should be reported separately" with 36200, 36245-36248, or 36140, CPT specifies.

Watch for: The cardiologist may place the catheters selectively into the renal arteries (which are first-order aortic branches) rather than the aorta. He also may perform contralateral lower extremity catheterization. When this occurs, you'll want to report the appropriate selective catheter placement code, such as 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family), rather than 36200.

In addition, cardiologists will often require catheter access from both the right and left femoral or iliac arteries. If the physician documents this, make sure to code each access site as a separate procedure and assign the appropriate catheter placement code(s) from each site as if it were a stand-alone procedure, says Jim Collins, CCC, CPC, president of CardiologyCoder.Com in Saratoga Springs, N.Y.

CPT allows you to report radiographic studies related to prosthesis selection and sizing separately.

You should select 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection,radiological supervision and interpretation) for an angiogram for endovascular AAA prosthesis placement (34800-34805).

For placement radiographic studies for extension cuff placement (34825-34826), report 75953 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation).

Remember that if the cardiologist performs supervision and a radiologist performs the interpretation, each should report the S&I code with modifier 52 (Reduced services) appended.

Less frequently, the cardiologist may place an occlusion device to block a stenosed or otherwise diseased iliac artery and prevent retrograde blood flow into the aorta. You should report this using +34808 (Endovascular placement of iliac artery occlusion device [List separately in addition to code for primary procedure]).

Code +34808 is an add-on code, which you should not report alone. CPT lists the acceptable codes with which you may claim +34808, including 34800, 34805, 34825, and +34806.