Cardiology Coding Alert

Question: Our question concerns reporting an abdominal aortogram at the time of cardiac catheterization. The cardiologist makes a separate selective injection into the abdominal aorta, reviews the films/images from that injection, and includes the findings from that study in the cardiac catheterization report. We need to know the codes for reporting the selective injection and the imaging interpretation.

Page 37 of the ACC Guide for 93544, aortography, states: "the catheter is positioned in the ascending aorta above the aortic valve," but the abdominal aorta is below the aortic valve. Since the abdominal aorta is not included in the 93544, would the correct codes be 36245 (selective catheter placement, arterial system; each first order abdominal, pelvic or lower extremity artery branch, with a vascular family), and 75625-26 (aortography, abdominal, by serialography, radiological supervision and interpretation)? Serialography was not performed because other cineangiography/ imaging procedures were used. We found no code for the interpretation of a study on the abdominal aorta other than serialography.

Alice Covell, CMA-A, RMA, CPC
Reimbursement Coordinator, Kalamazoo Cardiology, Kalamazoo, MI

Answer: The correct code for the interpretation of the study of the abdominal aorta is 75625 with modifier -26 (professional component) attached, says Terry Fletcher, BS, CPC, CCS-P, president of Physician Reimbursement Solutions, a coding and reimbursement firm in Laguna Beach, CA. She adds that if the procedure was selective, meaning the injection extended beyond the abdominal aorta into the arterial system, then the reader would be correct in identifying 36245 as the appropriate code for the procedure itself. The National Correct Coding Initiative does not contain an edit for the two catheterizations, Fletcher says, and Medicare has left it to individual carriers regarding whether they bundle such cardiovascular procedures. Further, coders should contact their Medicare carriers or the HCFA office in their district to determine if the procedures are bundled, she adds.
In the case described by the reader, however, an operative report would be needed to determine if the procedure was selective or not. If the procedure was non-selective, it should not be billed because selective and non-selective procedures cannot be billed together, says Susan Callaway-Stradley, CPC, CCS-P, an independent reimbursement and coding consultant in North Augusta, SC. She adds that some third-party payers will allow the abdominal aortogram to be coded 93544 if the need for such a procedure is clearly documented.