Cardiology Coding Alert

Question: How should I code the following?

Percutaneous entry into the right femoral artery was obtained . . . Selective renal angiography was obtained. This revealed widely patent renal arteries. The left renal artery had minimal stenosis with no gradient across this ... The right renal artery was also widely patent with no evidence of stenosis. Aortography also revealed no evidence of any accessory renal arteries.

I believe the correct codes are 36200 and 75625-26 (aortography, abdominal, by serialography, radiological supervision and interpretation, professional component). My cardiologist selected 36245 and 75724-26. Who is correct?

Virginia Subscriber

Answer: Your physicians coding is closer to the documentation provided. The note does not, however, indicate that bilateral renal angiography was performed, explains Martha Gerant, CPC, a coder with Cardiology Services, an 11-physician practice in Shawnee Mission, Kan.

The cardiologist is correct to choose 36245 (selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) because the notes clearly states, Selective renal angiography was obtained. Code 36200 (introduction of catheter, aorta), by contrast, describes a nonselective catheter placement. Similarly, although the operative note describes aortography, the selective renal angiography should be coded because physicians are instructed to code to the highest level of selectivity in this case, the renal angiography.

Based on the documentation, there is no justification for billing the bilateral renal angiography as described by 75724 (angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation). Although the note indicates images from both renal arteries were obtained, this does not necessarily mean that the catheter was placed in both arteries. Images could have also been obtained via the runoff from a single-side renal angiogram or from the aortography described in the operative note.

If the cardiologist did perform bilateral renal angiography, an addendum to the operative report should expressly indicate that fact. For example, the cardiologist could state, The left renal angiogram indicated minimal stenosis, while the right renal angiogram showed no stenosis. In the absence of such documentation, 75722-26 (angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation, professional component) should be used instead.

Note: If the renal angiography was bilateral, 36245 should be appended with modifier -50 (bilateral procedure).