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Cardiology Coding Alert

Attack This Arteriogram, Angioplasty Scenario and Come Out Coding Both Services

See which catheter placement code you should use based on access site Your cardiologist performed a diagnostic arteriogram followed by a balloon angioplasty of the right superficial femoral artery (SFA). Now you're wondering, should you report the arteriogram separately? Solution: Yes, says Yvette Hofmeister, CPC, coding analyst at OSU Internal Medicine in Columbus, Ohio. You may report the diagnostic arteriogram in this case, because the arteriogram determined the need for the angioplasty. Depending on how the cardiologist accessed the SFA, you should also report the appropriate catheter placement code, in addition to the related supervision and interpretation radiology code.

Keep in mind: Without the word "diagnostic" in the scenario above, you would not report the arteriogram as well. "If the physician knew about the blockage in the SFA from a previous session and only did the angiogram to scope out other things on the way to ballooning the SFA, or to find his way there (mapping), I wouldn't report it," says Deb Ovall, CMA, CCS, CIC, outpatient coder and interventional specialist at the University of Toledo Medical Center. Follow this expert coding advice and rest assured that you're reporting the most accurate claim possible.
Punch Out the Correct Puncture Codes First, let's look at your possible catheter code choices. More commonly, cardiologists use an access site in the groin area with advancement of the catheter in an antegrade fashion into the SFA. For these cases, you should report 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the access site was in the common iliac or 36246 (... initial second-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) if the access site was in the common femoral. For a contralateral puncture (meaning vascular access in the opposite leg with catheter advancement through the distal abdominal aorta), choose 36247 (... initial third-order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family).
If the cardiologist created the catheter puncture ipsilateral to the SFA (on the same side of the body), you could code for direct placement of the catheter into the superficial femoral artery (36140, Introduction of needle or intracatheter; extremity artery). However, this is an extremely rare access site.
Watch Modifiers With Radiology S&I Second, when your case involves radiology supervision and interpretation (S&I), you need to report the radiology S&I for the diagnostic study with 75710-26-59 (Angiography, extremity, unilateral, radiological supervision and interpretation; professional component; distinct procedural service). Modifiers explained: If the cardiologist performed these procedures in the facility setting, you should append modifier 26 to any radiology codes you claim. Also, you should append modifier 59 to 75710 to indicate that [...]

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