Cardiology Coding Alert

Question: When performing a left heart catheterization, the physician stated that he also performed a lower-extremity angiogram. Should I report this lower-extremity angiogram with 75710 for a unilateral procedure?

Wisconsin Subscriber

Answer: If the physician performed the lower- extremity angiogram for diagnostic purposes and the procedure was unilateral, you could report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) for non-Medicare patients. For Medicare patients, however, you should report G0278 (Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation [list separately in addition to primary procedures]).

Make sure, however, to confirm that the unilateral extremity study was diagnostic and that the physician performed the procedure to evaluate some symptom or concern. Cardiologists will frequently perform unilateral angiography to assess the vascular access site for deployment of a closure device. Medicare has clarified that a "provider should not report an associated imaging code such as CPT code 75710 or HCPCS code G0278" when placing "an occlusive device such as an angioseal or vascular plug into an arterial or venous access site after cardiac catheterization or other diagnostic or interventional procedure." (For Medicare's full discussion of the issue, visit the CMS Web site at www.cms.hhs.gov/physicians/cciedits/chap11.pdf.)

Moreover, CMS created G0269 (Placement of occlusive device into either a venous or arterial access site, post-surgical or interventional procedure [e.g., angioseal plug, vascular plug]) to "assure proper reporting of this service." CMS indicates in the Dec. 31, 2002, Federal Register, however, that G0269 has a status indicator that bundles this procedure into other services.  The Federal Register specifies that "the work, practice expense, and malpractice risk of closing an arteriotomy or venotomy site at the conclusion of an invasive percutaneous procedure, whether by manual compression, suture, or use of a closure device, is included in the main invasive procedure. Therefore, there is no separate payment for this procedure."