Cardiology Coding Alert

Question: Documentation shows a left heart catheterization and a lower-extremity angiogram. Should I report this lower-extremity angiogram with 75710 for a unilateral procedure?

Arizona 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. Append modifier 26 (Professional component) to indicate you’re reporting only the physician’s services. You will also need to append a modifier to 75710 to override the edit with the cardiac catheterization.

For Medicare patients, however, you should report G0278 (Iliac and/or femoral artery angiography, non-selective, 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]). You should not use modifier 26 with G0278 because it does not have separate professional and technical components. (Check private payer rules to confirm whether they require G0278 use.)

Careful: Confirm that the unilateral extremity study was diagnostic and that the physician performed the procedure to evaluate a documented symptom or concern. Cardiologists may perform unilateral angiography to assess the vascular access site before deploying a closure device. Medicare has clarified in Chapter 11 of the Correct Coding Initiative manual that “placement of an occlusive device such as an angio seal or vascular plug into an arterial or venous access site after cardiac catheterization or other diagnostic or interventional procedure should be reported with HCPCS code G0269 [Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g. angioseal plug, vascular plug)]. A physician should not separately report an associated imaging code such as CPT^® code 75710 or HCPCS code G0278.” (You can download the manual from the bootom of this page: www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.)

Note that Medicare does not reimburse physicians for reporting G0269, but you may report it for tracking purposes.