Cardiology Coding Alert

Question: One doctor at our facility consistently documents that he performed a femoral angiogram during a left heart cath procedure, when he has also done an LV gram and a coronary angiogram. Is either the left femoral angiogram or the femoral angiogram excluded from 75710 bundling?

Kentucky Subscriber

Answer: The answer depends on why the physician is doing the femoral angiogram. Because he consistently documents the femoral angiogram with the left heat catheterization, the LV gram, and the coronary angiogram, he is probably performing the femoral or iliac angiogram to see the exact location of the access site to determine whether he can use a closure device. If so, the femoral angiogram is not separately billable under 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation).

How it works: During these procedures, the physician makes a puncture in the patient's groin area through one of the arteries, through which she threads the catheter. After the doctor performs the heart catheterization, she comes back just above the point where she made the puncture and administers a small injection of contrast to help illustrate the exact location of the puncture.

The doctor uses this process to determine whether she can use a closure device. These devices help the patient become ambulatory faster than if the physician obtained hemostasis with direct pressure (for instance, using a sandbag).

Sometimes, however, a doctor performs a diagnostic lower-extremity study at the same time as the heart catheterization, and in those cases, you may bill for both the catheter placement and the imaging. But it has to be a diagnostic study -- not a procedure the physician performs just to identify if he can use a closure device. The applicable catheter placement and diagnostic coding guidelines will dictate the proper billing for these procedures.