Cardiology Coding Alert

Question: How should I report the following procedure: The physician inserted a catheter into the right brachial artery. He performed an injection of the abdominal aorta with distal runoff into left iliac and common femoral arteries. He noted a lesion in the left common iliac. He advanced a guiding catheter into the left common iliac across the lesion and positioned a stent under fluoroscopy. He noted no residual stenosis post-procedure and no gradient across the lesion.
      
South Carolina Subscriber

Answer: First, you should code for the angiographic services. According to the physician's documentation, this includes abdominal aortography with runoff (75630-26, Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation; professional component) and the angiography necessary for stent placement (75960-26, Transcatheter introduction of intravascular stent[s], [noncoronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel; professional component). 
 
The highest-order catheterization in the vascular family would be the first-order catheterization of the left common iliac artery. You would not report a separate code for the nonselective placement in the abdominal aorta. Report 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) for the first-order catheter placement. Finally, report 37205 (Transcatheter placement of an intravascular stent[s], [noncoronary vessel], percutaneous; initial vessel) for the stent deployment in the left common iliac.