Cardiology Coding Alert

Hint: 2 different catheter sites may mean reporting an additional code

If you're not sold on an abdominal angiography code, you should base your choice on one key factor - location, location, location. Take this coding quiz to see if you're the master of peripheral vascular coding or if you need to brush up on your PV basics.

1. True or false: When a physician performs an abdominal angiography, she can perform a "flush aortography" or an "abdominal runoff" from the same catheter position.

Answer: True. When you see "flush aortography" in the physician's documentation, you should report CPT 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation). For "abdominal with runoff," you should report 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation).

Tip: You don't need to know the size of the catheter or how much dye the physician used - but you do need to know where the physician placed the catheter, says Deb Ovall, CMA, CCS, CIC, lead coder and data quality analyst for Medical College Hospitals of Ohio at Toledo.

2. What is the correct code for runoff imaging?

Answer: You can't choose a code simply on "runoff imaging" - you need more information. Catheter placement is key here, says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn.

For instance, you should report runoff imaging from a single injection in the proximal abdominal aorta (suprarenal) as 75630-26 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation; professional component) with proper interpretation of the abdominal aorta and bilateral extremities.

In another example, when the cardiologist interprets information of the bilateral extremities when the runoff imaging is from the distal (above bifurcation) aorta, you should report 75716-26 (Angiography, extremity, bilateral, radiological supervision and interpretation; professional component).
 
"These scenarios focus on lower extremities, but the terminology can also apply to higher areas of the aorta - even the individual extremities," Karl adds.

Hint: Keep in mind that you can't separately report subsequent studies from the same catheter position, such as a complete runoff study.

3. Code this scenario: The physician performs an imaging of the abdominal aorta in one catheter location, and bilateral vessels runoff from another position in the aorta.
Answer: Again, you need to know the exact location of the catheter. If the cardiologist places it at the suprarenal abdominal aorta and performed an angiogram, then repositions it to the distal aorta just above the bifurcation for a bilateral iliofemoral angiogram, you should report 75625-26 (Aortography, abdominal, by serialography, radiological supervision and interpretation; professional component). For the extremity angiography, you'd report 75716-26. The key is location, Karl says.
 
If the physician performs the imaging from two different sites, you can usually report the extremity code (75716) separately. But if she sticks to one location for the aorta and runoff vessels, report 75630 only.

Tip: Be sure the physician's documentation supports billing for both the abdominal aortography and the extremity angiography by indicating that she injected dye at two separate locations. Keep in mind that certain "abdominal-only" studies - such as an abdominal aortic aneurysm evaluation or renal information - allow for a complete abdominal study.

4. Code this scenario: The physician performs an abdominal aortogram with runoff study. Following the study, she moves the catheter from the nonselective location in the aorta to a selective location in the contralateral common iliac artery and performs selective imaging.

Answer: For these procedures, you would report both 75630 and +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]). Remember that you can use 75774 in addition to both selective and nonselective codes. When the doctor performs a basic examination and then selectively places the catheter to obtain extra imaging, add 75774.

Also, make sure you report the selective catheter placement service with 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family).

Suppose the physician starts the imaging at the femoral level, and then shifts the catheter to the popliteal level to image the tibioperoneal vessels. Your code for this situation would be 75774.

Warning: Don't report 75774 unless you're certain the physician performed additional selective catheter movement.