Radiology Coding Alert

Watch for unilateral and bilateral services to be sure you have the proper code.

Renal angiography sports four new codes effective Jan. 1, 2012. Key elements distinguishing the codes include whether the service is first order or higher and whether the service is unilateral or bilateral:

• 36251, Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), 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
• 36252, ... bilateral
• 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
• 36254, ... bilateral.

Tip: When reporting the new renal codes, do not report bilateral superselective code 36254 in conjunction with bilateral first-order code 36252, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. You'll find this instruction in the 2012 CPT® guidelines.

You also should not report unilateral superselective code 36253 in conjunction with unilateral first-order code 36251 "when performed on the same renal/kidney," Neighbors adds.

Compare Your 2011 and 2012 Options

The addition of 36251-36254 means you'll no longer use a code from 36245-+36248 (Selective catheter placement, arterial system...) to report the catheterization. And because imaging services are included in the new codes, CPT® deletes 75722-75724 (Angiography, renal ...).

Example: The physician performs a first-order diagnostic study of the left renal artery, confirming fibromuscular dysplasia (447.3, Hyperplasia of renal artery).

For 2011 dates of service, you would have reported 36245 (first-order cath placement) and 75722 (unilateral renal angiography).

For 2012 dates of service, you should report 36251 to capture both the cath placement and the renal angiography.