Radiology Coding Alert

Question: If the radiologist performs diagnostic renal angiography followed by stent placement, may we report both the diagnostic angiography and the intervention?

Ohio Subscriber

Answer: You may report both the diagnostic and interventional services assuming you meet specific requirements in the CPT^® Vascular Procedures guidelines. To report the same-session diagnostic angiography, make sure the case meets one of these requirements:

1. There is no previously performed catheter-based renal angiography available, the radiologist performs a full diagnostic study, and “the decision to intervene is based on the diagnostic study”

OR

2. Although a prior study is available, the medical record indicates:

a. The patient’s clinical status has changed since that study; OR

b. The study is inadequate, so the physician can’t visualize anatomy/pathology; OR

c. “There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.”

Example: The radiologist performs an initial diagnostic angiography of the right main renal and determines the patient requires a stent. At the same session, the radiologist places the stent percutaneously, providing radiological supervision and interpretation.

You should report the intervention services using the following codes:

·         37205, Transcatheter placement of an intravascular stent(s) … initial vessel

·         75960-26, Transcatheter introduction of intravascular stent(s) … radiological supervision and interpretation, each vessel; Professional component.

For the diagnostic angiography, report a single code:

·         36251, Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including … radiological supervision and interpretation … unilateral.

Note that CPT^® guidelines indicate you should append modifier 59 (Distinct procedural service) to the diagnostic service to show it’s separate from the intervention. Chapter 5, Section D.12, of the Correct Coding Initiative (CCI) manual offers similar advice. CCI edits do not bundle 36251 with 37205 or 75960, so some payer requirements for appending 59 may vary.

CPT^® Assistant (April 2012) adds that when the intervention is based on a prior angiogram (i.e., 36251 isn’t reportable), your coding should reflect component coding conventions, such as 37205 (stent), 75960 (RS&I), and catheter placement code 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family).