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General Surgery Coding Alert

Reader Question:

Diagnostic Arteriogram

Published on Tue Jan 01, 2002

Question: The patient has a diagnostic arteriogram followed by balloon angioplasty of the right superficial femoral artery (SFA) with stent placement. Can I code for the arteriogram?

Nebraska Subscriber
 
Answer: The diagnostic arteriogram is payable because it determined the need for the other procedures. Depending on how the SFA was accessed, the appropriate catheter placement code should be billed, in addition to the related supervision and interpretation radiology code.
 
If the catheter puncture was ipsilateral to the SFA (on the same side of the body), 36245 (selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) should be reported. If the puncture was contralateral, 36246 ( initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) or 36247 ( initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family), depending on the start-off point, should be billed. The radiology supervision and interpretation for the catheter placement should be reported using 75710 (angiography, extremity, unilateral, radiological supervision and interpretation).
 
Note: If the procedures are performed in a facility, modifier -26 (professional component) should be appended to any radiology codes that are reported, to show that the surgeon did not own the equipment involved (i.e., the technical component).
 
The femoral angioplasty is coded 35474 (transluminal balloon angioplasty, percutaneous; femoral-popliteal), and the stent is coded 37205 (transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel). Both codes have associated radiology supervision and interpretation codes: 75962 (transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation) and 75960 (transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel).
 
Since it is unlikely that the stent placement and the balloon angioplasty will be paid separately, only the stent (and its associated supervision and interpretation code) should be billed. Because the diagnostic angiography led to the decision to perform the interventions, it is paid separately. This should be indicated with modifier -58 (staged or related procedure or service by the same physician during the postoperative period) appended to the more extensive intervention that followed (in this case, the stent, 37205).
 
You Be the Coder and Reader Questions were answered by Marcella Bucknam, CPC, a general surgery coding and reimbursement specialist and a coding instructor at Clarkson College in Omaha, Neb.; Susan Callaway, CPC,  CCS-P, a coding and reimbursement specialist in North Augusta, S.C.; M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C.; Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.; and Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.

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