Vol. 15 •Issue 12 • Page 10
Coding Corner
Coding Interventional Radiology Studies, Part 2
(Editor’s note: This is Part 2 of a two-part column. Part 1, published in the May 9 issue, presented the details of “Case Study: Bilateral Selective Renal Angiography Followed by Supraselective Studies of the Right Renal, Selective Study of Accessory Right Renal Artery.” The code assignments and rationale for that case study are provided below.)
Code Assignments
ICD-9-CM Codes
441.1 Thoracic aneurysm, ruptured
599.7 Hematuria
CPT Codes
The following codes should be assigned for this report. See below for further explanation and coding tips.
75724 Angiography, renal, bilateral, selective (including flush aortogram), radiological supervision and interpretation (S&I)
36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
75774 Angiography, selective, each additional vessel studied after basic examination, radiological S&I
75774 Angiography, selective, each additional vessel studied after basic examination, radiological S&I (List separately in addition to code for primary procedure)
75774 Angiography, selective, each additional vessel studied after basic examination, radiological S&I (List separately in addition to code for primary procedure)
36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family
36246 Initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family
36248 Additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)
CPT Code Assignment Rationale
Code 75724. The first code listed above describes the basic examination performed before the evaluations of the accessory renal artery and the two branches. (See below under Code 75774 for information on additional evaluations.)
Note that some coders make the mistake of also reporting code 75722 (angiography, renal, unilateral, selective, including flush aortogram, radiological S&I) with modifier 59. Do not report this code (with or without modifier 59) because the national correct coding initiative (CCI) edits considers it to be a component of 75724.
Another common error made is the separate reporting of 75625 (aortography, abdominal, by serialography, radiological S&I). Do not list this code because the correct code 75724 includes the aortogram.
Code 36245. Four separate catheter placements are described in the case study. Report code 36245 twice—once for the catheter placement within the main left renal artery and once for placement within the right accessory renal artery. Both placements represent first-order catheterizations because the catheter was placed in a vessel that arises directly from the aorta.
Code 75774. Approximately 30 percent of the population has an accessory renal artery, which is considered a normal anatomic anomaly. You would report code 75774 three times: for the angiographic evaluation of the accessory renal artery, for the evaluation performed on the anterior branch of the main renal artery and for the evaluation performed on the posterior branch of the main renal artery. Note that code 75774 requires “selective” evaluation.
Code 36246. The report states that the catheter was initially placed in the main right renal artery to perform selective angiography. It was subsequently advanced into the anterior and posterior branches of the main renal artery. The advancement indicates that the physician positioned the catheter beyond the first branch (main renal artery) into secondary branches of the main renal artery. The positioning of the catheter within the anterior branch represents a second-order catheterization, which is identified by 36246.
The catheter placement within the posterior branch of the main renal artery also represents a second-order catheterization. However, current coding guidelines do not allow 36246 to be reported a second time if the catheterization is performed within the same vascular family.
The main right renal artery has its origin off the aorta and is also the origin of the right renal artery’s vascular family. Therefore, any and all branches of the main right renal artery are considered one vascular family.
Code 36248. Report this code for the catheterization of the posterior branch. It describes the further selective catheterizations within a given vascular family. It is referred to as an “add-on” code because it is reported in addition to the initial catheterization code.
Bernie Van Someren is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.
