Cardiology Coding Alert

Question: Our cardiologist positioned a catheter in the patient's aortic arch and performed an aortic angiogram, which showed normal anatomy. The angiogram also indicated stenosis in the left common carotid artery, left subclavian artery and beyond the internal mammary. Next, the cardiologist selectively engaged the left common carotid artery and accomplished selective angiographies in multiple oblique views, including intracranial injections. The angiography indicated stenosis in the distal left common carotid and left external carotid artery. The left internal carotid at the bifurcation site had a calcification. Intracranial injections demonstrated some left-to-right flow through the middle cerebral artery. The physician then used a catheter to selectively engage the right common carotid artery. Multiple injections were accomplished, as well as intracranial views. The distal right common carotid was 90 percent stenosed. The right internal and right external carotids were normal. Intracranial flow was also normal. Wisconsin Subscriber Answer: First, report 36215 (Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family) for the catheter placement in the left common carotid artery. Append modifier -59 (Distinct procedural service) to 36215 to indicate a separate catheter placement into a first-order vessel not in the same family as the right common carotid artery. Report 36216 (... initial second order thoracic or brachiocephalic branch, within a vascular family) for the catheter placement in the right common carotid artery. For the aortic arch aortogram, report 75650 (Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation). Use 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) for the supervision and interpretation (S&I) of the left subclavian artery.

To indicate an angiogram after basic examination of the left carotid artery, report +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]) with 36215. Report 75774 again for the angiogram after basic exam of the right carotid artery. Append modifier -59 to 75774 to indicate that the angiogram after basic exam was a separate and distinct procedure.

Finally, report 75685 (Angiography, vertebral, cervical, and/or intracranial, radiological supervision and interpretation) for the angiography S&I of the left vertebral artery and 75685 again for the angiography S&I of the right vertebral artery. For the second reporting of 75685, append modifier -59 to indicate that the S&I is separate from the first S&I procedure. Keep in mind that you can't code the interpretation of the external carotids because the cardiologist did not selectively catheterize them. You also wouldn't report the catheter placement in the aorta or the subclavian arteries because the physician moved the catheters further and selected the carotids. You would report 75680 (Angiography, carotid, cervical, bilateral, radiological supervision and interpretation) for the [...]