Cardiology Coding Alert

Tip:  Find out how your payers want you to report bilateral cath placements

Stop having to appeal denials for renal angiographies your cardiologist performs on the same day as a cardiac catheterization. Follow this expert advice and get your claim paid the first time every time. First, Start With 2 Renal Study Codes If you're reporting selective renal angiography on the same day as the cath, you would report two codes:

• 36245--Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family

• 75724--Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision and interpretation. Here's why: The first code is specific to the selective catheter placement for the renal study. The second code shows the bilateral radiologic imaging of these arteries. Focus on Bilateral 36245 Payers, however, vary on the way they prefer you to report bilateral selective catheter placements. The most common examples are:

• 36245-LT (Left side) and 36245-RT (Right side),

• 36245-LT and 36245-RT-59 (Distinct procedural service),

• 36245-50 (Bilateral procedure), or

• 36245-50-59. Each of these accurately reports that you are billing for bilateral selective renal artery catheterization, but your payer may only automatically adjudicate the claim with one particular approach.

"Some insurance companies, such as National Heritage Insurance Company and BCBS [Blue Cross Blue Shield], require one line, one unit with modifier 50 attached. Others require two lines with modifier 50 on the second, but I feel it makes sense for us to code them with modifiers RT/LT," says Carolyn MacDonald, CPC, coding manager of the New England Health Care Foundation in Boston. "Using this method, we don't get rejections--but that may not work for other states."

Make the call: You need to identify the proper way to bill for these services to ensure proper and efficient reimbursement. Your first line of action is to call your various carriers and ask how they prefer you code these procedure. You might also review your claim history to identify the preferred billing method of your payers. "Each carrier can have their own way of wanting to see these services reported, so this can vary at times," says Angela N. Andersen, CPC, coding and documentation quality assurance at the Department of Defense, Division of the Navy, NMCP in Portsmouth, Va. Be Wary of Modifiers With 75724 You'll also have to be careful about modifiers when reporting 75724. Because 75724 is a bilateral code, you won't be able to report it with any of the bilateral modifiers (such as 50, LT or RT), MacDonald says. Clinically, the code represents the cardiologist engaging both renal arteries (right and left) and visualizing them.

You'll most likely report modifier 59 with this code quite frequently. You should also be prepared to include [...]