Cardiology Coding Alert

Question: The cardiologist sees an inpatient for acute claudication/ischemia of the foot and recommends peripheral vascular angiography with possible intervention. The same day, the cardiologist performs angiography and mechanical thrombectomy of the patient's left popliteal artery via the RCFA. Which codes should we report?

Georgia Subscriber

Answer: In this case, you should report the following codes and modifiers:

• An evaluation and management (E/M) code, such as 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). You should attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to show that the service was significant and separate from the procedures the cardiologist performed the same day.
• A diagnostic angiography code, 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). You'll append 75710 with modifier 26 (Professional component), XU (Unusual non-overlapping service), or 59 (Distinct procedural service) and LT (Left side) to indicate that you're coding only the angiography's professional component. This is the only service the cardiologist performed that has separate professional and technical components.
• Popliteal artery thrombectomy code 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel)

A catheter placement code, such as 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family). You'll append 36247 with modifier LT to indicate that you're coding a third order on the left side of the body.