Radiology Coding Alert

Question: My radiologist performed an abdominal aortography and discovered no evidence of abdominal aortic aneurysm. The operative report states, "There was significant aortoiliac tortuosity without clear stenosis seen on the nonselective angiogram." Which codes should I use for both a Medicare and non-Medicare patient?

Indiana Subscriber

Answer: The coding method remains the same for Medicare and non-Medicare patients. To correctly code this service, you should review the full operative report for more specific details. Because you specified the angiogram as nonselective, however, we can narrow the field for you.
 
Regardless of the access site location (sometimes called the puncture site or "stick" site), code the catheter placement with 36200 (Introduction of catheter, aorta). Most likely, your radiologist performed a complete study of the abdominal aorta, which means that you should use 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation). This service may include several injections in different views (anterior-posterior, left anterior oblique, and right anterior oblique) or just a single injection.
 
If your radiologist studied not only the abdominal aorta but also the iliac arteries and the proximal (or common) femoral arteries from the same catheter position, you should bill 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) for your service.
 
But because you only reference the aortoiliac area, you must review the medical record as well as any  images from the study to ethically choose between the potentially billed services of 75625 (aorta only) and 75630 (aorta, iliac and proximal [or common] femoral arteries).
 
For your diagnosis, you should report 447.9 (Unspecified disorders of arteries and arterioles) unless the imaging findings reveal a more specific diagnosis, such as atherosclerotic vascular disease.