Radiology Coding Alert

Put your first- and second-order know-how to the testCPT may be adding more all-inclusive codes every year -- covering a procedure and guidance in a single code -- but capturing every element of an interventional procedure still takes some serious sleuthing.Work your way through this real report and determine which CPT codes you would use. Then check your answers below.Review Selective Catheterization RulesYou have to work your way through the report's first few sentences to find the first reportable code. You should submit 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) to reflect the left internal iliac artery subselection, says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, with HealthTexas in Dallas. (Figure 1 on page 59 shows the anatomy involved.)Reason: You should choose second-order code 36246 because the first-order artery is the common iliac, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y.And the CPT guidelines for vascular injection procedures instruct you that "selective vascular catheterization should be coded to include introduction and all lesser order selective catheterization used in the approach." Translation: Don't report the right femoral artery puncture and left common iliac artery selection separately.Decide When RS&I Codes Are AppropriateYou should report 75736 (Angiography, pelvic, selective or supraselective, radiological supervision and interpretation) for the DSA performed in two projections, French says. Term tip: "DSA" stands for "digital subtraction angiography."Don't forget: If you're reporting only the physician's services, append modifier 26 (Professional component) to the radiological supervision and interpretation (RS&I) services, Scott says.Capture Reportable Angiography and EmbolizationAs you work your way through the report, you'll next come to the left internal iliac embolization. You should report this embolization with 37204 (Transcatheter occlusion or embolization [e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation], percutaneous, any method, non-central nervous system, non-head or neck) and 75894 (Transcatheter therapy, embolization, any method, radiological supervision and interpretation), French says.For the completion angiography in the left internal iliac artery, you should report 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion), French says.Again, append modifier 26 to the RS&I codes (75894 and 75898) if you report the professional component only, Scott says.Face the First- and Second-Order QuestionFor the right internal iliac artery selection, you should report 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family), French says. This is a separate vascular family from the left leg (which you reported earlier), so you should code a second catheter placement. You should report a first-order code because it's a branch of the vessel punctured, she says.CPT guideline: [...]