Cardiology Coding Alert

Solution: Yes, says Yvette Hofmeister, CPC, coding analyst at OSU Internal Medicine in Columbus, Ohio.

You may report the diagnostic arteriogram in this case, because the arteriogram determined the need for the angioplasty. Depending on how the cardiologist accessed the SFA, you should also report the appropriate catheter placement code, in addition to the related supervision and interpretation radiology code.

Keep in mind: Without the word "diagnostic" in the scenario above, you would not report the arteriogram as well. "If the physician knew about the blockage in the SFA from a previous session and only did the angiogram to scope out other things on the way to ballooning the SFA, or to find his way there (mapping), I wouldn't report it," says Deb Ovall, CMA, CCS, CIC, outpatient coder and interventional specialist at the University of Toledo Medical Center.

More commonly, cardiologists use an access site in the groin area with advancement of the catheter in an antegrade fashion into the SFA. For these cases, you should report 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the access site was in the common iliac or 36246 (... initial second-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the access site was in the common femoral.

For a contralateral puncture (meaning vascular access in the opposite leg with catheter advancement through the distal abdominal aorta), choose 36247 (... initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family).
If the cardiologist created the catheter puncture ipsilateral to the SFA (on the same side of the body), you could code for direct placement of the catheter into the superficial femoral artery (36140, Introduction of needle or intracatheter; extremity artery). However, this is an extremely rare access site.

Second, when your case involves radiology supervision and interpretation (S&I), you need to report the radiology S&I for the diagnostic study with 75710-26-59 (Angiography, extremity, unilateral, radiological supervision and interpretation; professional component; distinct procedural service).

Modifiers explained: If the cardiologist performed these procedures in the facility setting, you should append modifier 26 to any radiology codes you claim. Also, you should append modifier 59 to 75710 to indicate that the cardiologist used the diagnostic arteriogram to make the decision to perform angioplasty. This will distinguish the diagnostic imaging reported with 75710 from the intervention imaging reported with 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation). Otherwise, a Correct Coding Initiative (CCI) edit would trigger denial of 75710.

You should report the femoral angioplasty with 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal) and 75962-26 for the S&I, says Theresa Dix, CCS-P, coder at East TN Heart Consultants in Knoxville.

Bonus: Did you know that you can report 35474 twice? If your cardiologist performs an angioplasty in the femoral and a second in the popliteal artery, you can report 35474 x 2, says Jennifer Bankhead, RHIT, CPC-H, CIC, specialized coding analyst for St. Joseph's Mercy Health Center in Hot Springs, Ark. Make sure you have documentation pointing out that the cardiologist performed the angioplasty in two different places.