Cardiology Coding Alert

Some cardiology coders, accustomed to the familiar pathways of the heart, may view the noncoronary vessels in the abdomen as a strange and unrecognizable territory. But learning a few basic coding techniques will help you navigate these conduits with ease. Indeed, the key to finding your way through this apparent maze of abdominal aortic vessels and accurately coding diagnostic procedures is keeping track of catheter placement during angiography and distinguishing between first-, second- and third-order vessels. You must know the difference between selective and nonselective codes and be able to pair the appropriate radiological supervision and interpretation (S/I) codes with the procedure codes, coding experts say.

Increasingly, cardiologists are performing more noncoronary diagnostic imaging, including imaging the abdominal aortic vessels. In the past, however, interventional radiologists imaged these vessels, so cardiology coders will need more and more expertise in reporting the correct codes for abdominal aortic vessel procedures to avoid payment denials. When coding angiography in noncoronary arteries, you need two basic components: the procedural code and a code for the S/I, stresses Cynthia Swanson, RN, CPC, a cardiology coding consultant with Seim, Johnson, Sestak and Quist in Omaha, Neb. The codes in combination allow for billing accuracy, whether one physician performs all the services or multiple physicians provide portions of services, she says. Coronary Problems Prompt Peripheral Vascular Studies If a cardiologist finds vascular disease in the coronary arteries, he or she may image the rest of the arteries in the body, including the abdominal arteries. For instance, a patient may have a Doppler echocardiography (93320 or 93325) that shows cardiovascular stenosis (429.2), and the cardiologist will decide to check for atherosclerosis of the extremities (440.20) as well, says Sheldrian Wayne, CPC, a cardiology coding specialist with Coding Strategies Inc. of Atlanta.

Remember that if the physician does not own his own equipment and performs the angiography in the hospital rather than in the office, you should append modifier -26 (Professional component) to the radiological S/I codes, says Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla. Watch Detours When Using Nonselective Codes Where the cardiologist directs the catheter determines whether you use a nonselective or selective procedure code in the 36200-36248 range. If the cardiologist inserts a catheter from a femoral artery puncture site into the abdominal aorta and the catheter never leaves this primary vessel, then you would report 36200 (Introduction of catheter, aorta) for nonselective catheter placement in the aorta, Swanson and Wayne say.

Report 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) for the lower-extremity radiological S/I, which includes imaging the renal arteries and the iliacs, Swanson says. Frequently, after a patient has had [...]