Cardiology Coding Alert

Bolster your knowledge of coding multiple angiograms with this example If you're coding for op reports for peripheral vascular procedures, don't be left in a daze. Learn how to code selective catheter placement by the highest order and report multiple angiograms along with an attempted percutaneous transluminal balloon angioplasty (PTA). Prime Yourself by Reading the Full Procedure Procedure: The cardiologist accessed the right femoral artery and performed an abdominal bi-iliac angiogram with interpretation of both iliacs and common femoral arteries. He followed with a selective cannulation of left common iliac and runoff of the left lower extremity. Then he performed bilateral selective renal angiography. Next, he performed a selective left CFA angiography with distal arterial runoff for selective visualization of distal vessels. The patient underwent a peripheral angioplasty with cryoplasty balloon of critical stenosis in the distal left SFA and left popliteal artery. He cannulated the left renal and crossed the lesion and performed a peripheral angioplasty (peripheral angioplasty of in-stent restenosis in the left renal artery).

Main point of confusion: "How should I code the selective left common iliac artery with access from the right femoral? Would that be first or second highest order?" asks Josefina Peredo, a coder at New Coast Cardiology in Gulfport, Miss. "Can I report anything for the attempted PTA?"

Here's how to break down this complicated procedure into codes, based on the expert advice of Deborah Ovall, CMA, CCS, CIC, lead coder and data quality analyst with Medical College Hospitals of Ohio at Toledo. Parcel Out 5 Stops to Pick Correct Codes Think of it this way: "It's just like taking a car trip - you've got your beginning, your final destination, and sight-seeing stops along the way. Sometimes you just look at stuff as you go by, and sometimes you stop and do something a little more fun," Ovall says.

1. The cardiologist accessed the right femoral artery and performed an abdominal bi-iliac angiogram with interpretation of both iliacs and common femoral arteries. The cardiologist followed with a selective cannulation of the left common iliac and runoff of the left lower extremity. The abdominal aorto-bi-iliac angiogram includes visualization of the abdominal aorta, bilateral common iliac arteries and distal runoff through the common femoral arteries. You should report 75630-26 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation; professional component) if the cardiologist took one shot (in other words, shot dye and took a picture) from one position in the aorta.

For the service described by "a selective cannulation of left common iliac and runoff of the lower extremity," you should report +75774-26 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for [...]