Cardiology Coding Alert

Question: One of our cardiologists performed a right superficial femoral angiogram with runoff, then a right popliteal percutaneous transluminal angioplasty (PTA) and angiogram, a complex PTA and angiogram to the right posterior tibial artery for limb salvage by the antegrade approach. How should I code this? South Carolina Subscriber Answer: The key is that the approach is antegrade, which means that the common femoral artery rather than the aorta becomes the first-order vessel. For the right posterior tibial artery selection, you would report 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family). For radiological supervision and interpretation (S/I), use 75710 and append modifier -26 (Professional component) if the physician performing the procedure does not own the equipment.

Then use 35474 for the popliteal PTA, and 75962-26 for the S/I. The PTA for the right posterior tibial is 35470, with 75962-26. You would also append modifier -59 (Distinct procedural service) to 75962 because the cardiologist also used 75962 for the imaging of the femoral artery. The reason for the PTA codes is that you use a separate angioplasty code for each vessel.