Cardiology Coding Alert

Question: The cardiologist performed a diagnostic arteriogram followed by balloon stent placement in the right superficial femoral artery (SFA). May I report the arteriogram separately?


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Answer: Yes, you may report the diagnostic arteriogram because the arteriogram determined the need for the following angioplasty. If this arteriogram was a unilateral study, you should report 75710-26 (Angiography, extremity, unilateral, radiological supervision and interpretation; professional component).

If the cardiologist imaged both of the lower extremities, you should report 75716-26 (Angiography, extremity, bilateral, radiological supervision and interpretation; professional component). And if the cardiologist performed these procedures in the facility setting, you should append modifier 26 (Professional component) to any radiology codes you claim.

Don't miss: You should also report the appropriate catheter placement code.  If the surgeon accessed the arterial system ipsilateral to the SFA (on the same side of the body), your catheter placement would most likely be 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family). You would use 36245 because the usual access site is the common femoral artery. From this access site, you should consider the catheter placement into the ipsilateral SFA as a first-order selective catheter position. 

For a contralateral puncture, choose 36247 (... initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) because the contralateral SFA will always be a third-order selective catheter position.
 
As for the stent placement, report 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel) with its associated radiology S&I code, 75960 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel).

You should also append modifier 59 (Distinct procedural service) to 75710 to indicate that the surgeon used the diagnostic arteriogram to make the decision to place the stent. You have to include a modifier because the current National Correct Coding Initiative (NCCI) edits bundle 75710 and 75960 together. NCCI, however, permits separate reimbursement when you append modifier 59 and justify its use in your documentation.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.