Cardiology Coding Alert

Question: My cardiologist states, "The common iliac artery was tortuous on the right side, and the left common iliac artery was incompletely visualized due to large abdominal aneurysm." This was following a cardiac cath in which the initial approach was the right side. Should I use 75716 (Angiography, extremity, bilateral, radiological supervision and  interpretation), or is only 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) correct because that is all the physician could visualize? Or should I report nothing in addition to the abdominal aortogram? The physician did not observe the femorals.

Nevada Subscriber

Answer: You need to provide more information in order to receive the accurate code, but in general, when Medicare patients receive nonselective imaging of the renal and iliac arteries at the time of a heart catheterization, you should report the service with Medicare G codes:

G0275 - Renal angiography, nonselective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure)
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 procedure).  With non-Medicare patients, you should check the op report to determine where the cardiologist positioned the catheter for each injection and what the exact findings of each study were. (For more information on this, see "Peripheral Vascular Coding Basics: 5 Tips to Clear Up Your Abdominal and Extremity Angiography Coding Confusion" in the February 2004 Cardiology Coding Alert.)