Radiology Coding Alert

Watch for: Payers include arteriotomy closure in these procedures, so be sure not to code it separately.

2. Place the Catheter Code

The two codes you'll use most often to denote catheter placement are 36200 (Introduction of catheter, aorta) and 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family), Wholey says.

You may also use a higher-order catheter code based on the puncture site and final position of the catheter, she adds. Bottom line: You'll use at least one catheterization code. Catheter placement is usually bilateral, and you'll need to follow your carriers' guidelines for reporting bilateral placement.

You may report radiologic S&I with endograft device placement codes. Following catheter placement, the physician often performs an angiographic road map. The corresponding radiologic code for this procedure is 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation). Make sure you only report this S&I code once per AAA repair procedure, and note that it also includes completion angiography, Wholey says.

3. Code for the Deployment of the Endoprosthesis

The correct coding for the intervention will depend on the site of the repair and the prosthesis type. CPT lists five codes describing repair and prosthesis:

Tip: Your physician probably refers to the device by the brand name rather than dictating the description, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga. What to do: Report 34802 for placement of a Gore Excluder or Medtronic AneuRx device, and report 34803 for placement of a Cook Zenith prosthesis.

Next: The physician must place proximal or distal extensions (cuffs) to treat endoleaks or if the aneurysm is longer than the prosthesis, Wholey says. Two surgical codes apply to these extensions:

Never: Don't use these codes for placement of the modules of a modular prosthesis - that's included in the deployment codes. Remember: You report these codes only once per vessel, so assign only one code if the physician places two or more cuffs in a single vessel.

You can also report radiological S&I with extension placement using 75953 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation). You can report this code once for each vessel treated with cuff placement. Watch for: As with 75952, 75953 includes completion angiography.

Double-Check for -26 and -62

You usually see AAA repair performed in a hospital setting. If the operating physician does not own the imaging equipment, append -26 (Professional component) to any 70000-series codes, Wholey says.

In the course of the AAA repair, the operating physician may also perform ancillary interventional procedures, such as embolization or renal stent placement. "If the procedures are performed outside of the 'target zone' of the endoprosthesis, and if medical necessity is established and documented, you can bill the procedures separately by using the proper modifier to indicate that your physician provided a distinct separate ancillary service," Miller says.

In many cases, AAA repair will involve the work of two physicians, each performing distinct parts of the procedure. For example, a surgeon may perform the surgical exposure (cutdown), while an interventional radiologist performs the catheter placement and the imaging. In such situations, each physician should report his distinct operative work. Append modifier -62 (Two surgeons) to AAA endograft repairs performed by both physicians. Each physician should report the cosurgery once using the same procedure code.
 
Example: A surgeon performs bilateral femoral cutdowns. A radiologist places the catheters bilaterally into the aorta and performs the supervision and interpretation. Both physicians place the modular bifurcated prosthesis. The surgeon's work would be reported as 34812-50 and 34802-62, while the radiologist's work would be reported as 36200-50, 34802-62 and 75952-26.