Cardiology Coding Alert

Question: The operative report states: "The guidewire was advanced across the aortic bifurcation into the left iliac system and angiography of the left iliac, femoral and superficial femoral arteries were obtained. Next with pullback into the right iliac system, right iliac femoral and superficial femoral angiograms were obtained." How should this session be coded? I've been told that 36140 is appropriate.

Minnesota Subscriber

Answer: Based on the information provided, the only codes that should be reported are 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) and 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation) with modifier -26 (Professional component) appended. There is no additional payment for placing the sheath into the extremity artery, so 36140 (Introduction of needle or intracatheter; extremity artery) should not be reported separately. In this case, access was obtained at the right femoral, and the final destination is the left iliac. Therefore, one turn was required, which is why a first-order selective code (36245) should be reported. Any other injections along the way, including those in the same vascular family where the procedure began, are included.

Reader Questions and You Be the Coder were answered by Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas; Linda Laghab, CPC, coding manager with Pediatric Management Group at Los Angeles Children's Hospital; Kathleen Mueller, RN, CPC, CCS-P, a cardiology coding and reimbursement specialist in Lenzburg, Ill.; Savanna Siens, CPC, CCS-P, billing manager with Mid-Atlantic Cardiology, a 45-member cardiology practice in Baltimore; Nikki M. Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.