Cardiology Coding Alert

New G Codes Alter Renal and Iliac Angiography Billing

Published on Thu May 01, 2003

If you're wondering how to apply G0275 and G0278 the new HCPCS codes for renal and iliac artery angiography after heart catheterization the directions from CMS are fairly simple: Use these codes for selective, nonselective, unilateral, or bilateral procedures.

Many cardiologists perform heart catheterizations and then assess the patient's peripheral vasculature for problems by imaging the renal and iliac arteries, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country.

The advent of the new codes will change the way you report heart caths with renal and iliac angiography to Medicare. Non-Medicare payers may have different requirements for billing renal and iliac imaging during heart caths, so check with insurers before using these codes.

Coders seeking detailed information regarding these new codes should consult the Federal Register on the Web at www.cms.hhs.gov/REGULATIONS, says Marsha Mason-Wonsley, a health insurance specialist with the Division of Ambulatory Services at CMS.

G Codes Replace Old Angiography Series

In 2002, you billed the catheter placement and any angiography services the physician provided with regular CPT codes. Specifically, coding experts indicate that they most frequently reported angiography of the renal and iliac arteries with combinations of the following CPT codes (which are still appropriate for many non-Medicare payers). Cardiology coders reported these codes in addition to the appropriate heart catheterization codes:

36245 First-order catheter placement

75710 Angiography, extremity, unilateral S&I

75716 Angiography, extremity, bilateral S&I

75722 Angiography, renal, unilateral S&I

75724 Angiography, renal, bilateral S&I.

In 2003, however, you should use 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]) when the physician performs angiography, either unilateral or bilateral, in the renal arteries following a heart catheterization, Collins says.

Use 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]) when the physician performs angiography (unilateral or bilateral) in the iliac arteries following a heart catheterization.

Codes G0275 and G0278 include catheter placement, injection, flush aortogram, and supervision and interpretation (S&I).

Screening Studies Still Not Covered

Collins stresses that these new G codes should not be interpreted as the establishment of a new Medicare covered "screening" service category, which would require an act of Congress.

Now, Medicare covers only a handful of screening services, such as colorectal cancer screening. Specifically, Medicare Carriers Manual Transmittal 1769 (Sept. 12, 2002), establishes that "When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of illness or injury, the testing facility or the physician interpreting the diagnostic test should report the screening code as the primary diagnosis code. Any condition discovered during the screening should be reported as a secondary diagnosis."

Therefore, without signs or symptoms suggesting peripheral vascular disease, you should report any "screening" peripheral vascular studies with a screening ICD-9 code as the primary diagnosis (for example, V81.2, Special screening for other and unspecified cardiovascular conditions), regardless of findings, Collins says.

Reimbursement Reflects Work

In its 2003 Physician Fee Schedule, CMS assigns total RVUs of 0.36 for both G0275 and G0278, which many see as inadequate for the work involved. This equates to about $12 each. Because the reimbursement is so low, some have assumed that these codes can't also include selective catheter placement, but CMS has confirmed that they do.

According to CMS' 2003 final fee schedule rule, the logic behind this low reimbursement amount is as follows:

"These procedures are performed frequently on Medicare patients."

"typical performance of these procedures involves the use of a pigtail catheter positioned in the aorta (not the renal or iliac artery[s])"

"injection of a minimal dye load (because of the heavy dye load already used for cardiac angiography)."

"a procedure time of approximately two and one half minutes."