Cardiology Coding Alert

Question: My cardiologist performed an abdominal aortography and discovered no evidence of abdominal aortic aneurysm. The operative report says, "There was significant aortoiliac tortuosity without clear stenosis seen on the nonselective angiogram." Which codes should I use for both a Medicare and non-Medicare patient? When should I use 93544? Indiana Subscriber Answer: Because the clinical scenario that you describe does not include a heart catheterization, the coding method does not vary for Medicare and non-Medicare patients. In order to correctly code this service, you should review the full operative report. However, since you specified the angiogram as nonselective, we can narrow down the field for you. Regardless of the location of the access site (sometimes called the puncture site or "stick" site), code the catheter placement as 36200 (Introduction of catheter, aorta). Most likely, your cardiologist performed a complete study of the abdominal aorta, which means that you should use 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation). This service may include several injections in different views (anterior-posterior, left anterior oblique, and right anterior oblique) or just a single injection. If your cardiologist accessed the abdominal aorta, the iliac arteries and the femoral arteries from the same catheter position, you should bill 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation). But because you only reference the aortoiliac area, you must review the medical record as well as any recoded images from the study in order to ethically increase the billed service from 75625 (aorta only) to 75630 (aorta, iliacs, and femoral arteries). You should use 93544 (Injection procedure during cardiac catheterization; for aortography) only if the physician performs an aortic root injection of the ascending aorta. During this procedure, the physician assesses problems such as aortic valve insufficiency, aortic root aneurysm, and aortic stenosis. You should not report 93544 when the cardiologist performs aortography without accompanying heart catheterization or coronary angiography. -- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.