Cardiology Coding Alert

 Home in on where the intervention actually takes place The more you practice coding for peripheral vascular procedure op notes, the less likely you'll be left in a daze when one lands on your desk. Learn the tricks of the trade to determine when a more complex procedure includes a lesser one and when you should use a modifier to report them separately. Read the Full Procedure History: A 73-year-old male with insulin-dependent diabetes and heart disease had a percutaneous transluminal coronary angioplasty (PCTA) three years ago. He now has drug-resistant hypertension, and testing indicates probable renal artery stenosis.
 
Op report: Physician draped and prepped right groin area and introduced a pigtail catheter to the aorta through a retrograde right common femoral artery puncture. Then performed a flush abdominal aortogram.
 
The initial study of the right and left renal systems revealed potential high-grade stenosis of the mid-left renal artery. The physician then performed both a left renal arteriogram using a curved catheter and a left renal artery cannulation. Selective diagnostic study of the left renal artery confirmed a high-grade occlusion suggestive of fibromuscular dysplasia (FMD). The right renal artery was only visualized from the flush abdominal aortogram. The artery and its branches were within normal limits.
 
The physician gave the patient 5,000 units of intravenous heparin. She then introduced PTA balloon catheter over the guidewire into the area of blockage in the left renal artery. She performed initial angioplasty with balloon. Upsized balloon; performed another dilation at the mid-vessel stenosis site in the left renal artery. Performed a final arteriography, which showed no residual stenosis and smoothly flowing contrast through left renal artery and parenchymal bed.
 
How should you report these procedures? Break the Report Down Coding from an op report doesn't have to be a daunting task. By breaking down each section, you can code step-by-step.
 
Part 1 of the op note: For example, look at "Physician draped and prepped right groin area and introduced a pigtail catheter to the aorta through a retrograde right common femoral artery puncture. Then performed a flush abdominal aortogram."
 
Solution: "Your catheter placement at this point is 36200 (Introduction of catheter, aorta)," says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn. Keep in mind: You won't report this code, because you have a selective renal catheter placement to follow.
 
Hint: You're going to include the flush aortogram (75625) in the selective renal study the cardiologist performs later, Karl adds.
 
Part 2 of the op note: "The initial study of the right and left renal systems revealed potential high-grade stenosis of the mid-left renal artery. The physician then performed both a left renal arteriogram using a curved catheter and a left [...]