Cardiology Coding Alert

Question: My cardiologist performed an abdominal aortogram with runoff study. Following the study, she moved the catheter from the nonselective location in the aorta to a selective location in the contralateral common iliac artery and performed selective imaging. How should I code this?

South Carolina Subscriber

Answer: For these procedures, you should report both 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) and +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]).
 
Remember that you can use 75774 in addition to both selective and nonselective codes. When the doctor performs a basic examination and then selectively places the catheter to obtain extra imaging, add 75774.
 
Also, make sure you report the selective catheter placement service with 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family).
 
Suppose that after the cardiologist performs the studies mentioned above (75630 and 75774), he moves the catheter to the popliteal artery to image the tibioperoneal vessels. In addition to “graduating” your catheter placement code from 36245 to 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family), you would report 75774 a second time.
 
Warning: Don’t report 75774 unless you’re certain the physician performed additional imaging after a basic study that involved movement of the catheter to a different selective position.