Cardiology Coding Alert

You do not have to settle for payment of a left heart catheterization with aortography of the aortic root when you also perform an abdominal aortogram as long as you provide documentation indicating the abdominal aortogram was used to image a separate problem. When a cardiac physician performs a left heart catheterization, he or she may also do an aortogram to obtain images of the aortic root where the aorta joins the heart. The physician may also perform these procedures during the same session as the more typical angiography of the left coronary chambers and the coronary arteries. In addition, the cardiologist may perform an abdominal aortography following a heart catheterization. For example, the cardiologist may have difficulty passing a guidewire and catheter through the access site the femoral artery to the aorta because the patient has an abdominal aortic aneurysm (441.4). The cardiac physician may perform an abdominal aortogram and heart catheterization simultaneously if the patient has an additional problem (such as abdominal aneurysm or leg cramps) that the cardiologist wants to assess at the same time. Aortic Root Aortography Does Not Include Abdomen Generally, you should report the aortography of the aortic root using 93544 (Injection procedure during cardiac catheterization; for aortography) with 93556 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]).

Any images obtained from injections in the ascending aorta the first section of the aorta from the left ventricle to the arch are included in 93544/93556. According to the American College of Cardiology, 93544 involves positioning the catheter in the ascending aorta above the aortic valve. The code, however, does not describe abdominal aortography. Even if aortography of the aortic root or elsewhere in the ascending aorta has already been performed and reported with 93544/93556, you should report the supervision and interpretation of the abdominal aortogram using either 75625 (Aortography, abdominal, by serialo-graphy, radiological supervision and interpretation) if only the aorta is imaged or 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialo-graphy, radiological supervision and interpretation) if the images of the iliac and/or femoral arteries are also obtained. These codes reflect the cardiologist's manipulation of the catheter as well as the interpretation of the images. If the cardiac physician performs these procedures in the hospital, you should append modifier -26 (Professional component) to the appropriate code (75625 or 75630) because the hospital provides the instruments and supplies for the procedure. In addition, because the physician uses the same catheter for the heart catheterization and the abdominal aortography, you should not bill an additional catheter placement code, e.g., 36200, [...]