Cardiology Coding Alert

Question: How should I code the following procedure: The physician placed a catheter in the right femoral artery and advanced a tipped wire through the patient's thoracic aneurysm to the root of the aorta and ascending segment. He then placed a pigtail catheter and performed aortic arch angiography in multiple projections with contrast injected through the pigtail catheter. He next selectively engaged the brachiocephalic artery on the right and performed multiple projections of the brachio-cephalic and right subclavian with the tip of the catheter in the proximal brachiocephalic artery. Then he removed the catheter and directed it into the left subclavian to perform left subclavian angiography. Wisconsin Subscriber Answer: First, you should report 36215 (Selective catheter placement, arterial system; each first order thoracic  or brachiocephalic branch, within a vascular family) and append modifier -RT(Right side) for the right brachio-cephalic catheterization. Report 36215 and append modifier -LT (Left side) for left subclavian artery catheterization. To report the bilateral extremity studies, you should use 75716-26 (Angiography, extremity, bilateral, radiological supervision and interpretation; professional component). Finally, report 75650-26 (Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation, professional component) for the initial aortic arch study.