Cardiology Coding Alert

Question: The physician performs contralateral selective catheter placement and angiography of the right common iliac, internal iliac, external iliac, femoral, superficial femoral artery (SFA) and profunda. How should I code this?

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 Answer: The profunda femoris, or deep femoral, is a branch of the common femoral, but it is not a branch of the SFA, which has coding implications.
 
This operative session should be coded as follows:
  36247 -- selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family -- third order into SFA;
 
36248 -- ... additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (list in addition to code for initial second or third order vessel as appropriate) -- for going into profunda;
 
75710 -- angiography, extremity, unilateral, radiological supervision and interpretation -- for the entire extremity just once; and
 
75774 -- angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure) -- once for the profunda.  
The catheter placement and angiography performed on all arteries listed in the question are coded using 36247 and 75710 because they are considered part of the same vascular family, with the highest-order placement into the SFA.
 
Because the catheter must be manipulated into the profunda femoris, this vessel is often referred to simply as the profunda (which means deep), and it is considered an additional third-order vessel. Therefore, the placement of the catheter in the profunda should be coded with 36248.
 
The same rationale applies to the selection of a separate radiology supervision and interpretation code. The angiography performed in the other arteries is reported as 75710 (for the entire extremity) and constitutes a basic examination, which does not include additional vessels. Angiograms that are taken in additional vessels after the basic examination are coded with 75774, which is reported appropriately in this case.