Cardiology Coding Alert

Question: Please explain how to code the following: The physician accessed the right femoral artery, inserted the catheter into the abdominal aorta and performed an aortogram, which visualized the renals. The physician then attempted to cross a total occlusion of the left renal artery. The aortogram revealed that there was a stent in the right renal artery with no residual stenosis. The physician exchanged a French sheath over the wire into the right femoral artery and attempted to cross the lesion, but due to lack of severity of the stenosis and tortuosity of the vessel, the wire would buckle and the guiding catheter would come out of the ostium of the left renal artery, despite multiple attempts. The physician terminated the procedure and performed another angiogram of the left renal artery. The left renal artery was still patent with 95 to 99 percent stenosis. Ohio Subscriber Answer: In general, if the catheter did not cross the lesion, you would not code the intervention. Based on the information provided, the wire apparently crossed the ostium of the renal artery, so you could use 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) for the catheter placement. You may want to append modifier -22 (Unusual procedural services) for the attempted intervention. The physician may have performed a selective renal arteriogram. In that case, you should use only 75625-26 (Aortography, abdominal, by serialography, radiological supervision and interpretation; professional component). If the physician performed a selective renal arteriogram, you should use +75774-26 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]) because CPT includes the aortogram in the selective renal arteriogram. Answers to Reader Questions and You Be the Coder were provided by Martha Gerant, CPC, professional coder and reimbursement specialist for Cardiology Services in Olathe, Kan.; Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.; Cynthia Swanson, RN, CPC, a cardiology coding consultant with Seim, Johnson, Sestak and Quist in Omaha, Neb.; and Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn.