Cardiology Coding Alert

Question: Recently, some insurance companies have been bundling bilateral selective renal arteriography with heart catheterizations. I have received at least three rejections stating that bilateral selective renal arteri-ography is not usually paid separately. Typically, carriers pay for the heart catheterization and the radiological supervision and interpretation code but not for the bilateral selective renals. Can you explain why? Maryland Subscriber Answer: Insurance companies may be bundling the selective renal arteriography into the heart catheterization codes because they may consider this procedure to be not medically necessary. You should check your diagnosis coding to demonstrate that the renal arteriography was done for a medically necessary reason. For instance, your payer may be looking for such diagnosis codes as those in the 403.xx range, indicating hypertensive renal disease, or 404.xx, indicating hypertensive heart and renal disease. If your diagnosis coding is correct, you may need to appeal the denials with the appropriate medical record documentation.