Cardiology Coding Alert

Question: One of our cardiologists performed a selective coronary arteriography and selective renal angioplasty. Both the left and the right renals were engaged, and the procedure was bilateral. How should this be coded, and which surgical code should I use?

Alabama Subscriber

Answer: The coronary angiograms would be coded as follows: 93508-26 (Catheter placement in coronary artery[s], arterial coronary conduits[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization; professional component), 93545 (Injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand]) and 93556-26 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]; professional component).

The bilateral renal angioplasties would be coded using 35471-50 (Transluminal balloon angioplasty, percutaneous; renal or visceral artery; bilateral procedure), 75966-26 (Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation; professional component) and +75968-26 (Transluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation [list separately in addition to code for primary procedure]; professional component).

For the selective renal arteriography, you would use 36245-50 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family; bilateral procedure) and 75724-26 (Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation; professional component).

Be sure to append the appropriate diagnosis codes to all of the procedures the cardiologist performed. For example, you would append coronary artery disease (414.01) to codes history, conduct a physical for coronary angiography and link renal atherosclerosis (440.1) to the codes for renal angioplasty.