Cardiology Coding Alert

Question: The cardiologist documented a PTA and stent of the left renal artery and the left "accessory" renal artery. What is an accessory artery, and how should this session be coded? Tennessee Subscriber Answer: Most individuals have one artery from the aorta to the kidneys, but some have a second, ancillary or accessory, artery. Interventions involving both arteries may be reported separately. Therefore, the session is coded as follows: 37205 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; initial vessel +37206 each additional vessel (list separately in addition to code for primary procedure)

35471 x 2 Transluminal balloon angioplasty, percutaneous; renal or visceral artery

36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family if the accessory renal artery comes off the primary renal or 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the accessory artery originates off the aorta.


If the cardiologist obtained the images, angiography should be reported as follows: 75722-26 Angiography, renal, unilateral, selective (including flush aortogram) radiological supervision and interpretation; professional component

75960-26 x 2 Transcatheter introduction of intravascular stent(s), (non-coronary vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel; professional component

75966-26 Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation; professional component

+75968-26 each additional visceral artery.
If the catheter was introduced via the common femoral artery, the furthest point the accessory renal artery qualifies as a second-order selective catheter placement (36246) if it is placed via the other renal artery (two turns), but the procedure should be coded 36245 if it comes off the aorta (only one turn). The stent in the renal artery is reported with 37205, and the stent in the accessory artery is coded 37206 because it is considered an additional vessel.

There is, however, only one code for renal PTAs (35471); because two PTAs were performed, the code may need to be listed on the claim form twice, or a 2 should be entered in the units box, depending on carrier preference. Note: The PTAs should not be separately reported if they were performed only to facilitate the placement of the stent. Answers to Reader Questions and You Be the Coder provided by Belinda Inabinet, CPC, technical support manager who heads a coding team at South Carolina Heart Center, a 21-physician practice in Columbia, S.C.; Linda Laghab, CPC, coding manager for Pediatric Management Group at Children's Hospital Los Angeles; Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb.; Rebecca Sanzone, CPC, director of reimbursement with Mid-Atlantic Cardiovascular Associates in Baltimore; Savannah [...]