Cardiology Coding Alert

You know you will need to report multiple codes when your cardiologist performs abdominal and extremity angiographies at the same session, but are you certain your claim fully reflects what your cardiologist did? Our experts shed light on common terminology and when to apply add-on codes.

Rationale: Physicians perform "a lot of peripheral vascular studies and interventions at the same time as cardiac caths -- and that always changes the coding technique for the peripheral procedures," says Christie Oji, manager for Island Cardiac Specialists in New York.

Our experts point out what matters most -- tracking the physician's catheter placement -- and highlight what coding combinations really mean.

To report an abdominal aortogram, use 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation), says Regina McLain, CPC, PCS, billing supervisor for Kentucky Cardiology in Lexington. This procedure is also known as a "flush aortography."

Think of it this way: You will use this code alone when the cardiologist views only the abdominal aorta, McLain says.

If the physician performs an abdominal aortogram and lower-extremity runoff, you would instead report 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation), McLain says. This procedure is often called "abdominal with runoff."

In other words: You'll use this code when the cardiologist places the catheter in the aorta and does not reposition it. Also, the cardiologist views the lower extremity along with the abdominal aorta, McLain says.

Difference: The difference between the abdominal angiography codes is that 75630 includes a runoff study (the physician visualizes the downstream vessels) but 75625 does not. However, keep in mind that either 75625 or 75630 might be applicable from the same catheter position. Specifically, the physician could image just the abdominal aorta or the aorta and the downstream vessels from the same catheter position.

Next, you should understand what imaging codes you will report.

Key: You'll report your imaging codes based on catheter position.

For instance, you can report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) for one extremity and 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation) for both extremities.

Tip: Provided the catheter is not moved, you should include all imaging studies, regardless of view, in 75710 or 75716, when applicable.

Other options include 75736 (pelvic) or +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]) for an additional selective after basic study.

75625, 75710: If your physician performs an abdominal aortogram and repositions the catheter to image a unilateral lower extremity, you should report 75625 and 75710, McLain says.

75625, 75716: If the cardiologist does an abdominal aortogram, repositions the catheter and then performs a bilateral lower-extremity angiogram, you would report 75625 and 75716. In other words, 75625 and 75716 are for imaging of the aorta and bilateral runoff vessels when the physician images the aorta at one cath position and performs the runoff after moving the catheter to another location.

Be wary of catheter movements: You've learned how catheter position makes a difference. However, catheter movement will not always support billing for a separate study, because some "abdominal only" studies (such as abdominal aortic aneurism evaluation) may include more than one catheter position. The operative note should reflect catheter movement, abdominal, and extremity study findings before you bill for the extremity study in addition to the abdominal study, coding experts say.

When to add 75774: If the physician performs additional imaging after a basic exam, you can report 75774. When the physician needs to see something better, and he moves the catheter to a more selective position and obtains further images, he can use this code.

Example 1: The physician performs a bilateral, non-selective lower-extremity runoff study (75716) from a distal aortic position. He then moves the catheter from the nonselective location in the aorta to a selective location in the iliac or femoral artery and performs additional selective imaging beyond basic. You should report 75774.

Example 2: If the physician moves the catheter after imaging at the femoral level to the popliteal to image the tibioperoneal vessels, you would use 75774 in addition to the basic imaging procedure (75710), experts say.

You should use the correct surgical catheter placement codes in addition to the appropriate imaging codes.

Keep in mind: When physicians perform nonselective studies of the renal arteries and iliac arteries on Medicare patients at the time of a heart cath, they should report HCPCS codes:

• G0275 -- Renal artery angiography (unilateral or bilateral) performed at the time of cardiac catheterization, includes catheter placement, injection of dye, flush aortogram and radiologic supervision and interpretation and production of images (list separately in addition to primary procedure)

• G0278 -- Iliac artery angiography performed at the same time of cardiac catheterization, includes catheter placement, injection of dye, radiologic supervision and interpretation and production of images (list separately in addition to primary procedure).

- Note: See future issues of Cardiology Coding Alert for more on peripheral cath placement coding using these G codes.