Radiology Coding Alert

Question: An interventional radiologist performs a renal angiogram on a patient with documented renal stenosis in the cath lab in order to guide the placement of an intravascular stent. Can I code both the angiogram and the stent placement?

Arizona Subscriber

Answer: Unless the radiologist performs the renal angiogram as a separate diagnostic service, you may not report 36253 (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; unilateral) in addition to 37236 (Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery).

In this example, the radiologist has already diagnosed the patient with stenosis and is using the renal angiogram as a guiding shot for placement of the intravascular stent. Therefore, you may only report code 37236 in this example.