General Surgery Coding Alert

Question: The surgeon performed diagnostic arteriogram followed by balloon angioplasty of the right superficial femoral artery (SFA) with stent placement. May I report the arteriogram separately?

Kansas Subscriber
 
Answer: Yes, you may report the diagnostic arteriogram in this case, because the arteriogram determined the need for the follow-up angioplasty. Depending on how the surgeon accessed the SFA, you should also report the appropriate catheter placement code, in addition to the related supervision and interpretation radiology code.
 
If the surgeon created the catheter puncture ipsilateral to the SFA (on the same side of the body), you could either code for direct placement of the catheter into the artery (36140, Introduction of needle or intracatheter; extremity artery) or, if it was moved into the SFA, you should report 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family).
 
For a contralateral puncture, choose 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 order of the branch into which the surgeon placed the catheter.
 
Report the radiology supervision and interpretation for the catheter placement with 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). You may describe the femoral angioplasty with 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal).
 
For the stent placement, claim 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel). You should report these procedures in addition to their associated radiology S&I codes: 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation) and 75960 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel), respectively.
 
If the surgeon performed these procedures in the facility setting, you should append modifier -26 (Professional component) to any radiology codes you claim. You should also append modifier -59 (Distinct procedural service) to 35474 to indicate that the surgeon used the diagnostic arteriogram to make the decision to place the stent.