Cardiology Coding Alert

Whether you're new to peripheral vascular (PV) coding or a seasoned veteran you've most likely been confused by reporting abdominal and extremity angiography at the same time. The key to coding both studies accurately is tracking the physician's catheter placement. Top PV coders offer five pointers to help you master these procedures:

1. Get Cozy With the Right Codes

You should be familiar with the four abdominal and extremity angiography codes as well as the common terms physicians use to describe these studies to report these procedures accurately.
 
For the abdominal study also known as "flush aortography " report 75625 (Aortography abdominal by serialography radiological supervision and interpretation). You can also report 75630 (Aortography abdominal plus bilateral iliofemoral lower extremity catheter by serialography radiological supervision and interpretation) often called "abdominal with runoff." The difference between the codes for abdominal angiography is that 75630 includes a runoff study (the physician visualizes the downstream vessels) but 75625 does not.
 
For full extremity studies you can report 75710 (Angiography extremity unilateral radiological supervision and interpretation) and 75716 (Angiography extremity bilateral radiological supervision and interpretation.)

2. Understand the 'Runoff' Concept

When coding for the abdominal angiography 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.
 
In the extremities however billing for any "runoff" imaging is not applicable. "There would be no additional or different code for a femoral study with or without runoff " says Anne Karl RHIA CCS-P CPC coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights Minn. "As long as the catheter is not moved all studies regardless of view would be included in the 75710 or +75774 (Angiography selective each additional vessel studied after basic examination radiological supervision and interpretation [list separately in addition to code for primary procedure]) when applicable."
 
So you should report the imaging code according to catheter position. For instance you could report the imaging with 75710 (one extremity) 75716 (both extremities) 75736 (pelvic) or 75774 (additional selective after basic study) depending on the procedure note.
 
Keep in mind however that any subsequent studies the physician performs from the same catheter position are not separately reportable (such as a complete runoff study). Indeed "there are no other 'runoff' codes other than 75630 " says Roseanne R. Wholey president of Roseanne R. Wholey and Associates in Oakmont Pa.

3. Check Catheter Position in the Aorta

When the physician performs abdominal or extremity angiography the billing is clear. But when he or she images the abdominal aorta and the extremities you must observe several critical conventions to ensure proper coding.
 
"Use code 75630 for imaging of the aorta and runoff vessels from one catheter position in the aorta " says David R. Zielske MD an interventional radiology and cardiology coding specialist and president of radiology and cardiology coding publishing company ZHealth Publishing of Brentwood Tenn. Zielske is also senior vice president with Ingram and Associates a billing and coding consulting firm in Brentwood.
 
" Codes 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 " Zielske says.
 
Therefore the physician's catheter movement is critical to support separate billing for either of the extremity angiography codes (75716 or 75710). Even so 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 and abdominal and extremity study findings before you bill for the extremity study in addition to the abdominal study coding experts say.
 
Wholey summarizes: To report an abdominal aortogram use 75625. If the physician performs an abdominal aortogram and lower-extremity runoff you would report 75630 instead. But if the physician performs an abdominal aortogram and repositions the catheter to image a unilateral lower extremity you would report 75625 and 75710. If the physician performs both an abdominal aortogram and bilateral lower-extremity angiograms you would instead report 75625 and 75716.

4. Don't Forget 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 Zielske says.
 
If for example the physician performs a runoff study and 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 " 75774 is appropriate Zielske says.
 
On the other hand you should not use 75774 for additional images without the additional selective catheter movement. "There is no code for additional oblique views from the same cath position " Zielske says.
 
You may think that you can list 75774 only in addition to another "selective" code but you can report this code with 75630 75710 or 75716 (all of which may be non-selective) because these codes represent the basic extremity imaging coding experts say.
 
For instance "Code 75630 could be a basic study if only a suprarenal shot with runoff was done from a single injection point followed by a selective study of either or both extremities " Karl says.
 
Indeed 75774 is appropriate whenever a physician performs a basic exam and then provides additional catheter work (selective placement) and additional imaging Zielske says. If for instance the physician moves the catheter "after imaging at the femoral level to the popliteal to image the tibioperoneal vessels then you would use 75774 in addition to the basic imaging procedure " Wholey says.

5. Add Your Cath Placement Codes

You should use the correct surgical catheter placement codes in addition to the appropriate imaging codes Wholey says. And cardiology coders should keep in mind that 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 and G0278 for these procedures. (See box on the left for the recently released G0275 and G0278 definitions.)
 
Note: Watch future issues of Cardiology Coding Alert for more on peripheral cath placement coding using these G codes.