Radiology Coding Alert

Avoid the mistake of billing these two types of abdominal angiographies together.

Physicians that routinely perform angiographies will commonly submit a Computed Tomography Angiography (CTA) abdomen/pelvis alongside an abdominal aorta CTA with lower extremity runoff (LER). Let’s review these two procedures:

• 75635, Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing
• 74174, Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

What’s the Difference?

There’s actually more to this question than what’s presented on the surface. The obvious differentiation between these procedures comes with the inclusion of the iliofemoral and runoff artery imaging of the lower extremities in 75635. Things get a little cloudier when » » determining whether a CTA abdominal aorta actually includes all that’s encompassed in 74174. “When performing an abdominal aorta CTA with LER, you are exclusively concerned with examining the aorta, the iliofemoral arteries, and the runoff arteries extending into the calf,” Barry Rosenberg explains.

“On the other hand, a CTA abdomen/pelvis is looking at the vessels extending from the aorta into the abdomen and pelvis – essentially cutting off at the groin,” continues Rosenberg. “Overall, there’s an extensive overlap between the area that these two procedures cover, from the abdominal aorta to the groin.”

Remove 74174 from the Equation

Your physician might offer a case arguing for the billing of both procedures, but the final (and only) word comes by way of your Correct Coding Initiative (CCI) edits. According to CCI, 75635 includes a complete angiographic evaluation of a patient’s abdomen, pelvis, and lower extremities. Therefore, if a situation presents itself in which both of these procedures are performed, only submit code 75635.

This rule also applies to 74175 (Computed tomographic angiography, abdomen, with contrast material[s], including noncontrast images, if performed, and image postprocessing) and 72191 (Computed tomographic angiography, pelvis, with contrast material[s], including noncontrast images, if performed, and image postprocessing).

Just in case: It’s worth noting that on the other end of the anatomical spectrum comes 73706 (Computed tomographic angiography, lower extremity, with contrast material[s], including noncontrast images, if performed, and image postprocessing). In case your physician opts to perform a CTA lower extremity alongside a CTA abdominal aorta/LER, you’ll want to follow the guidelines above and remove 73706. As 73565 already includes an examination of the arterial vessels of the lower extremities, coding both procedures would be redundant (and against CCI edits).