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Cardiology Coding Alert

You Be the Coder:

Does Bilateral Renal Code Apply?

Published on Thu Oct 09, 2014

Question: Codes 36251-36254 vary based on whether the service is first order, second or higher order, unilateral, or bilateral. If the cardiologist does a first order service on one side and a second order service on the other side, should I report 36254 for bilateral superselective because it represents the higher order?

California Subscriber

Answer: When the cardiologist performs first order renal angiography on one side of the body and second or higher order renal angiography on the other side, you should report each service separately.
CPT® Assistant, August 2012, states that the correct coding for this scenario is:
  • 36251, Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
  • 36253, Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral.
Correct Coding Initiative edits bundle 36251 into 36253, so you’ll need to append a modifier to override the edit. You may use modifier 59 (Distinct procedural service) on 36251, or you may use RT (Right side) and LT (Left side) on the appropriate codes, depending on payer preference.

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