Radiology Coding Alert

Interventional radiology cases are among the most difficult to code for three reasons:

multiple areas of anatomy are often involved,

lengthy dictation is typical to describe the numerous steps and techniques involved, and

multiple combinations of radiological supervision and interpretation (S & I) codes as well as surgical procedural codes are required.

So interventional coding trainer Gary Burns, MBA, RRA, has come up with a five-step approach that seems to cut through the confusion of coding these complex cases. This approach can be applied to almost any interventional radiology case, adds Burns, principal of Medical Asset Management, Inc., a national training and contract coding auditing firm in Atlanta. Here is Burns five-step method:

1. Catheter Access Points. Identify and note documentation of all the catheter access points.

Tip: If multiple access points are used, a code for each access point is appropriate.

2. Catheter End Points. Review documentation and identify all catheter end points. Remember you are looking for a description of the most selective vessel catheterized within each vascular family accessed. For example, if a catheter is placed in a first order vessel for angiography and then the second order vessel is selected, the second order (more selective) vessel is coded and not the first order vessel, even though an angiogram was performed at the first order site. Then appropriate supervision and interpretation codes may be used for each service performed.

3. Radiographic Exams. Next, code for all separately defined radiographic examinations (not views) with appropriate supervision and interpretation codes.

4. Supervision and Interpretation. Then, for each separate exam, code all appropriate instances of supervision and interpretation based on vessels visualized and interpreted.

5. Vascular Abnormalities. Finally, identify and code any vascular abnormalities (i.e., with ICD-9 Codes ).

With these five steps in mind, read the following note which describes a case of head and neck arterial angiography:

Case Description

The right groin was draped and prepped in the usual sterile fashion. Using a pigtail catheter, an initial digital arch injection was performed. The catheter was then exchanged for a Headhunter catheter followed by selective injection of the right common carotid, left common carotid, left vertebral artery, and right subclavian artery for visualization of the right vertebral.

The right common carotid injection demonstrates minimal plaque at the level of the carotid bulb extending into the internal carotid with an estimated cross-sectional stenosis of approximately 30 percent. There is [...]