Radiology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: I want to make sure I'm not overcoding the following: Abdominal aortography is performed using a 5-French catheter via a left percutaneous transfemoral arterial approach. The catheter tip is retracted to the aortic bifurcation for pelvic arteriography in multiple projections. The catheter tip is placed at the aortic bifurcation and positioned in the right external iliac artery for right lower extremity arteriography. The tip is retracted into the left external iliac artery for left lower extremity arteriography. Which codes should I assign for the procedure itself? Also, should I bill CPT 75774 in this case?

New Jersey Subscriber

    Answer: The coding of angiography must include the surgical or procedure codes that describe the catheter placements and vessel selections, and the radiology supervision and interpretation (RS&I) codes that describe the supervision of the imaging and nursing personnel involved in the procedure and the interpretation of the imaging studies. The procedures in this case include a nonselective catheter placement in the aorta, the repositioning of the catheter (still nonselectively, but lower in the aorta), and the subsequent selective catheterization of the contralateral and ipsilateral iliac arteries for additional selective angiography.
 
The nonselective catheter placement code (36200) is not reported because component-coding conventions "bundle" nonselective catheter placements into selective catheterizations when both are performed through the same access point. Therefore, the only surgical codes that should be reported are 36140 (Introduction of needle or intracatheter; extremity artery) to describe the selective catheter placement into the ipsilateral iliac artery and 36246 (Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family) to reflect the work for the selective catheter placement in the contralateral iliac artery. Code 36140 has two potential uses, one to describe the direct nonselective catheter placement into an extremity artery, and the second as used in this case to describe ipsilateral selective catheter placement when performed in conjunction with a contralateral vascular selection. In addition, two RS&I codes would be used: 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) for the aortography and 75716 (Angio-graphy, extremity, bilateral, radiological supervision and interpretation) for the bilateral angiography. This combination of RS&I codes is correct because the nonselective aortic catheter was repositioned after the aortogram and prior to obtaining the non-selective bilateral lower extremity angiogram.
 
Also, this radiology practice may bill two units of add-on code +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]) because selectives after the basic exam (75716) were done.