Radiology Coding Alert

Question: Our radiologists frequently perform venous access port checks. This test consists of injecting the port with contrast and then, under fluoroscopic guidance, checking for obstructions or other problems with the device. What is the correct way to code this service?

Illinois Subscriber

Answer: Prior to Jan. 1, 36005 (Injection procedure for extremity venography [including introduction of needle or intracatheter]) would have been the correct code to assign because it closely describes the service provided (the port is in the vein).

In the introduction section of CPT 2002 (page X), the AMA established new instructions about reporting services not precisely described by an existing code. Coders are instructed to "select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code." In the past, these directions simply noted that coders should "select the name of the procedure or service that most accurately identifies the service performed" without giving further instructions to use unlisted-procedure codes.

If the radiologist evaluates the catheter and site and examines the patient, you should use an E/M code (e.g., 99213, Office or other outpatient visit, established patient). In most instances, the medical decision-making component will drive the code selection for the E/M service because only two of the three key components must be documented for a follow-up evaluation. Therefore, the physician should clearly document either history or exam, with medical decision-making. As an alternative, unlisted-procedure code 36299 (Unlisted procedure, vascular injection) may be assigned. Because of the confusion surrounding this issue, professional organizations like the Society for Cardiovascular and Interventional Radiology have created workgroups to discuss and recommend changes to CPT.

However, if the radiologist checks the catheter by placing an additional intravenous catheter either selectively or nonselectively, the catheter placement should be reported using the appropriate codes from the 36000 series. Finally, if a study is performed to answer specific clinical questions about the status of the superior vena cava, the radiological supervision and interpretation code for the study (75827, Venography, caval, superior, with serialography) should be reported regardless of the method used to introduce contrast.