Cardiology Coding Alert

Question: Is there a procedure code for sheath injections only? One of our doctors did a selective injection within the sheath. The report states that the patient was brought back to the ICU complaining of abdominal discomfort. After consultation with the radiologist and cardiac surgery, the physicians agreed that an angiogram of the femoral artery and the iliac artery via the sheath would be helpful. Selective injection within the sheath was done without incident.

New York SubscriberAnswer: In general, you would use a code that includes the injection. In the situation you describe, the appropriate code is 36140 (Introduction of needle or intracatheter; extremity artery). You would also need to use the corresponding radiology code, 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation), to which you would append modifier -26 (Professional component).

Answers for You Be the Coder and Reader Questions were provided by Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; Rebecca Sanzone, CPC, billing manager for Midatlantic Cardiovascular Associates of Baltimore, Md.; Anne Karl, RHIA, CCS-P, CPC, a coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn.; Catherine Brink, CMM, CPC, president of Healthcare Resource Management of Spring Lake, N.J.; and Charol Spaulding, CPC, CPC-H, vice president of Coding Continuum, Inc. of Tucson, Ariz.