Radiology Coding Alert

Code 75625 replaces G0275, and J0151 replaces J0152. 

Your radiology practice needs to align to changes in the angiography and adenosine codes that CMS introduced in the recently posted HCPCS 2014 file. Here is an update on the non-selective renal angiography and adenosine coding to that will help you to adapt to these changes with ease.

Remember: Both of these changes affect claims with dates of service on or after Jan. 1, 2014.

Make Sure You Delete G0275 from Your Coding Cache

For years, one sign of the veteran radiology coder has been knowing how to properly apply G0275 (Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins [ostia] of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation [List separately in addition to primary procedure]). 

Not many other specialty coders would know to look to a G-code to report non-selective renal angiography performed with a cardiac catheterization for a Medicare patient.

But according to the latest HCPCS update, G0275 has been deleted effective Dec. 31, 2013. Guidance on a replacement has not yet been issued, but experts note that 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) may be appropriate to capture a non-selective renal angiogram performed with a cardiac catheterization. “If a complete abdominal aortogram is performed, then you will now report code 75625,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA. “Catheter placement code 36200 (Introduction of catheter, aorta) is NOT used, because it has a zero Correct Coding Initiative (CCI) edit with a heart catheterization.”

Code 75625 represents imaging the abdominal aorta with the catheter placed in the aorta. Similarly, G0275 essentially described a service where, after the physician performed a cardiac or coronary catheterization, he pulled the catheter back through the aorta, paused above the renal arteries, injected dye, and allowed it to run into the renal arteries for visualization. 

Before reporting a code for this service in 2014, be sure the documentation supports medical necessity for the code you report, as you would for any other diagnostic study. Based on the diagnoses that supported G0275, possible supporting diagnoses for 2014 are hypertension (e.g., ICD-9: 401.x; ICD-10: I10) and chronic kidney disease (e.g., ICD-9: 585.x; ICD-10: N18.x).

Reality check: Be extremely careful when coding CPT® 75625 with a heart catheterization. When your radiologist does renal and cardiac angiographies together, you may apply modifier 52 (Reduced services) for the service of injection to view the renal arteries. “CPT® 75625 should be reported with a 52 modifier if there is only a brief mention of the renal vessels and no mention of the aortic, visceral, or other abdominal vessel,” Hembree says.

Keep in mind the G0275 service was specific to NON-selective angiography of the renal arteries. Consequently, selective renal angiography codes 36251 (Selective catheter placement [first-order], main renal artery and any accessory renal artery[s] for renal angiography, including arterial puncture and catheter placement[s], fluoroscopy, contrast injection[s], image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral) through 36254 (Superselective catheter placement [one or more second order or higher renal artery branches] renal artery and any accessory renal artery[s]) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection[s], image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral) would not be appropriate replacements for a non-selective service. You report CPT® codes 36251-36254 when your radiologist does both a non-selective abdominal aortography and selective renal angiography(s). In this instance, you do not report code 75625.

2. Watch the 29 mg Difference for Adenosine Units

Another noteworthy change for radiology coders is the deletion of J0152 (Injection, adenosine for diagnostic use, 30 mg [not to be used to report any adenosine phosphate compounds; instead use A9270]). In its place, you’ll use J0151 (Injection, adenosine for diagnostic use, 1 mg [not to be used to report any adenosine phosphate compounds, instead use A9270]). “J0152 has been deleted and in its place you can report J0151. Coders need to be careful and watch the dosage. J0151 is reported as 1 mg per unit, and the old code was 30 mg per unit,” says Hembree.

The difference between the two codes is the number of mg per unit:

• 2013: J0152 was reported as 30 mg per unit.
• 2014: J0151 is reported as 1 mg per unit.

This is a difference you can’t afford to miss. If you’re accustomed to reporting 1 unit for 6 mg adenosine, for example, and you accidentally report that 1 unit in 2014, you’ll be losing out on 5 units of reimbursement. You should report 6 units of J0151 for 6 mg adenosine.

Tip: Adenosine is sold under brand names such as Adenoscan.