Secret tips for CPT code for Angiography coding

How to code Angiography coding
The femoral artery. (Photo credit: Wikipedia)
Angiography is an x-ray study of the blood vessels that helps physicians diagnose and treat medical conditions. Angiography uses a radiopaque substance (dye) to make the blood vessels visible under x ray.
Their is a particular CPT code for angiography of different vascular sites in the body. The radiological supervision and interpretation of the placement of catheter has to be coded with the major surgery procedure codes.

Procedure performed by Angiography Procedures

After giving local anesthesia to the access site like any of the peripheral arteries, the physician makes an arterial puncture. Then a guidewire is inserted to assist the catheter to advance into the respective peripheral artery. The catheter is advanced to the target point with the help of fluoroscopy and then the guidewire is removed. The physician, with the help of continuous images obtained, visualizes respective bilateral extremity arteries for any abnormalities after injecting contrast medium. This code is reported by a radiologist to describe the "radiological supervision and interpretation (RSI)" part of a surgical procedure performed on a patient. This code reports only the radiologist's service in the entire procedure.

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Scenarios for coding CPT code for Angiography


1. Question: Can I bill for any "runoff" imaging services when my cardiologist performs a femoral study?

Answer: No, you should not report any additional or different code for a femoral study with or without runoff. As long as the cardiologist does not move the catheter (meaning the MD positions the cath once and performs all of the studies from the femoral artery and downstream from that position), you should include all of the imaging in the appropriate angiography code.

You can report femoral angiograms with a few different codes depending on the study's content. If the physician did only a lower extremity study, you would report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation). If the physician selectively injects the femoral artery after a basic study (such as 75716, Angiography, extremity, bilateral, radiological supervision and interpretation), your code is +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]).

Impact: You should report the imaging code according to catheter position. For instance, you could report the imaging with 75710 (one extremity), 75716 (both extremities) or 75774 (additional selective after basic study), depending on the procedure note.

Keep in mind; however, you cannot separately report any subsequent studies the physician performs from the same catheter position (such as a complete runoff study). Indeed, you won't find any other "runoff" codes other than 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation).

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2. Question: What CPT codes should I report when the physician performs angiography on both legs and one arm?

Answer: You should report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) and 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation). Append modifier 59 to 75710.

Why? National Correct Coding Initiative edits bundle unilateral angiogram code 75710 into bilateral angiogram code 75716 with a modifier indicator of 1, meaning that you may override the edit when the services are at separate encounters or on separate anatomic areas.

When you report the two legs with the bilateral code and the one arm with the unilateral code, you are reporting separate anatomic areas, so you may override the edit.

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3. Question: My cardiologist performed an abdominal aortogram with iliofemoral runoffs with visualization of the lower extremities. Can I report both 75630 and 75710?

Answer: If the cardiologist repositions the catheter within the aorta (for instance, he performs one study from high in the abdominal aorta and then repositions the catheter at the aorto-iliac bifurcation), you should report 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation). Depending on if he studied one or both extremities, assign 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) or 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation).

If the cardiologist does not reposition the catheter, you should report only 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation). Rationale: Code 75630 includes visualization of the same anatomic territory as the combined work of 75625 and 75716.
Question: You Be the Coder in Radiology Coding Alert, Vol. 11, No. 6, included the scenario below. The article suggested coding 75630, 75774, and 36247. But shouldn’t you report 75716 instead of 75630? Scenario: Right common femoral artery was used and a 5 French sheath inserted. I advanced an Omniflush catheter into the distal aorta and performed an aortoiliac bifemoral angiogram. Then I passed a wire up and over into the left superficial femoral artery and brought a glide catheter over into the artery and performed a runoff from the SFA down to the feet. Iliac pictures taken on left with an Omni catheter and iliac pictures on right taken through a 5 French sheath. Right leg runoff taken through 5 French sheath.
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Answer: When the radiologist documents findings for the aorta, bilateral iliofemoral, and left leg, the following codes are correct:
“75630 -- Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography,radiological supervision and interpretation
“+75774 -- Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure)
“36247 -- Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch,within a vascular family.

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