Tempted to report 75625? Think twice or risk refund requests. Coding peripheral vascular services in addition to cardiac catheterizations is one of the trickiest areas of an already tricky specialty. Case in point: To keep your claims in the clear, master these essential pointers for G0275 (Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins [ostia] of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation [List separately in addition to primary procedure]). Jump 3 Hurdles Before Reporting G0275 Before submitting a claim for G0275, be sure you consider these three requirements: 1. Medicare patient: Payers that follow Medicare guidelines may choose to accept the code, but you should check with the individual payer before submitting G0275, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. 2. Cardiac cath, too: 3. Non-selective: Dive Deeper Into When G0275 Does and Doesn't Apply The G0275 service essentially describes a service where, after the physician performs a cardiac or coronary cath, he pulls the catheter back through the aorta and pauses above the renal arteries. The physician "shoots the dye and allows it to run into the renal arteries," says Chandler. The service may sound straightforward, but payers still have specific requirements for medical necessity, like any other diagnostic study. The documentation needs to show the renal angiography was medically reasonable and necessary. The G0275 service is usually done in patients with certain types of "hypertension, CKD [chronic kidney disease], previous renal artery stenosis, or renal failure," says Chandler. For instance, First Coast Service Options, Part B MAC for Florida, lists very specific requirements for the service in LCD L29941: 1. Suspicion for atherosclerotic renal artery stenosis (RAS) must be high, as defined by additional criteria in the policy, such as malignant hypertension or unexplained renal failure, AND 2. "There are reasonable anticipated therapeutic implications for which the results of this angiogram will be used," AND 3. "The results of noninvasive imaging studies cannot be obtained or are inconclusive." Providers reporting to Trailblazer have a similar set of defined indications (LCD L31450). An important reminder in the Trailblazer policy is that the coverage requirements for renal angiography with cardiac cath are just as strict as for renal angiography performed as a separate service. In either case, coverage is considered if noninvasive imaging isn't available, conclusive, or appropriate for a patient with: Bottom line: Avoid G0275 for Selective Services If the physician decides a patient requires selective renal catheterization, you should not report G0275. This is true even when the physician performs both non-selective and selective renal angiography. You should bundle the non-selective service into the selective. In other words, "if the physician states that the catheter was placed in the renal artery, that completely wipes out" G0275, says Chandler. Remember that there are four new codes for selective renal angiography in 2012. Key elements distinguishing the codes include whether the service is first order or higher and whether the service is unilateral or bilateral: Reminder: Watch for the Uncommon Aortogram In rare cases, the physician may decide a patient requires abdominal aortic angiography based on medical necessity. In particular, the physician may suspect abdominal aortic aneurysm (AAA) based on what he sees on the cardiac cath, leading him to perform a diagnostic aortogram before removing the catheter from the patient. In these rare cases, you should report an aortography code, such as 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation). Code G0275 would not apply because the purpose of the imaging is to look at the aorta rather than the renals. Similarly, +93567 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography [List separately in addition to code for primary procedure]) would be incorrect, says Neighbors. Smart move: Beware: Try a Renal Angiography Example Suppose the cardiologist performs left heart catheterization with LV-gram in addition to right and left coronary angiography, documenting findings. Then, due to a history of uncontrolled hypertension, the physician withdraws the catheter in the aorta, stops above the renal arteries, and performs contrast injection to view the renals, finding 70 percent stenosis on the right. You should report: