Cardiology Coding Alert

Hint: Vascular families determine which codes you'll reportThink you can capture every element of a peripheral vascular procedure and keep straight CPT's all-inclusive codes? Test yourself by working your way through this real report and determine which CPT codes you would use. Then check your answers below.Heads up: "A coder should always review the patient's anatomy, the physician's intentions and indication, the procedural description, and the outcome of the procedure -- before coding the procedure itself," says Christina Neighbors, MA, CPC, ASC-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash.First, Read the Procedure NoteReport: Right femoral artery punctured. Catheter used to cross over the aortic bifurcation into the left iliac system. Left common iliac artery was selected. Subselection was made of the left internal iliac artery. DSA performed in two projections. Embolization was carried out using Gelfoam. Completion angiography was performed in the left internal iliac artery.The catheter was pulled back into the right common iliac, followed by selection of the right internal iliac artery. Right internal iliac angiography was performed in two projections. Embolization was carried out using Gelfoam as well. Completion angiography was performed.Review Selective Catheterization RulesYou have to work your way through the report's first few sentences to find the first reportable code. You should submit 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) to reflect the left internal iliac artery subselection, says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, a coding consultant with HealthTexas in Dallas.Reason: You should choose second-order code 36246 because the first-order artery is the common iliac, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y.And the CPT guidelines for vascular injection procedures instruct you that "selective vascular catheterization should be coded to include introduction and all lesser order selective catheterization used in the approach." Translation: Don't separately report the right femoral artery puncture and left common iliac artery selection.Decide When RS&I Codes Are AppropriateYou should report 75736 (Angiography, pelvic, selective or supraselective, radiological supervision and interpretation) for the DSA performed in two projections, French says. Term tip: "DSA" stands for "digital subtraction angiography."Don't forget: If you're reporting only the physician's services, append modifier 26 (Professional component) to the radiological supervision and interpretation (RS&I) services, Scott says.Capture Reportable Angiography and EmbolizationAs you work your way through the report, you'll next come to the left internal iliac embolization. You should report this embolization with 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) and 75894 (Transcatheter therapy, embolization, any method, radiological [...]