Radiology Coding Alert

Question: A vascular surgeon performs an endovenous ablation therapy of the right greater saphenous vein. This procedure involves ultrasound (US) guidance and the provider sends the US images to a radiologist for a subsequent interpretation. What US code should I report for the interpreting radiologist’s services?

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Answer: In some instances such as the example above, a radiologist will interpret US-guided images that are considered an inclusive component of the underlying procedure. You can see that US guidance is included in the code description for the vascular surgeon’s portion of the surgery, as outlined in code 36475 (Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated).

In order to receive compensation for the radiological interpretation, the radiologist will need to partake in some sort of contractual arrangement with the primary surgeon. Billing out separately with code 76998 (Ultrasonic guidance, intraoperative) is redundant and will almost always result in a denial.

Not only does the code description for 36475 include “all imaging guidance and monitoring,” you’ll also see the parenthetical notes underneath code 76998 state that it may not be reported in conjunction with 36475, among other codes. This is backed up further by a National Correct Coding Initiative (NCCI) modifier “1” indicator between the two codes.