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:
If the cardiologist obtained the images, angiography should be reported as follows: 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. 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 Siens, CPC, CCS-P, a cardiology coding and reimbursement specialist in Kansas City, Mo.; Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.
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.