Radiology Coding Alert

Ignoring serialography codes? You could be losing deserved dollars

Component coding for individual interventional procedure elements increases your risk of missing a code for your claim -- and reimbursement for your practice. Take control with this expert advice on nonselective procedures.

Tackle Tough Arterial Claims With These CPT Skills

You should consider either of the following to be nonselective arterial catheter placement, says Stacy Gregory, RCC, CPC, of Tacoma, Wash.-based Gregory Medical Consulting Services, in her audioconference for The Coding Institute, “Success Strategies for Interventional Radiology Vascular Coding” (get your own CD at www.audioeducator.com):

• the radiologist places the catheter or needle directly into an artery and does not manipulate or move it into a branch
• the radiologist moves the catheter or needle into the aorta from any approach with no further manipulation.

Remember: You should code each vascular access separately, Gregory says.

The codes you’ll use for nonselective arterial catheterization include the following, Gregory says:

• 36100 -- Introduction of needle or intracatheter, carotid or vertebral artery
• 36120 -- Introduction of needle or intracatheter; retrograde brachial artery
• 36140 -- ... extremity artery
• 36145 -- ... arteriovenous shunt created for dialysis (cannula, fistula or graft)
• 36160 -- Introduction of needle or intracatheter, aortic, translumbar
• 36200 -- Introduction of catheter, aorta.

Example 1: The radiologist performs a nonselective arch aortogram to evaluate the great vessels. If he performs and documents a femoral or axillary approach, with the catheter in the ascending aorta, you should report 36200 and 75650 (Angiography, cervicocerebral, catheter, including vessel origin, radiological supervision and interpretation), Gregory says.

Example 2: The radiologist performs an abdominal aortogram (from a femoral or brachial approach), placing the catheter in the upper abdominal aorta. You should report 36200 and 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation), Gregory says.

Common mistake: Don’t let the term “serialography” confuse you and convince you not to use 75625 when appropriate. “Serialography is the technique of taking radiographic images in rapid sequence for the study of high-speed phenomena (such as the flow of blood through an artery). This is more commonly referred to as multiple rapid sequence imaging,” Gregory says.

Discover How Options Change With Vena Cava

Nonselective venous catheter placement involves either of the following, Gregory says:

• the radiologist places the catheter or needle directly into a peripheral vein and does not manipulate or move the catheter or needle further into a branch
• the radiologist moves the catheter or needle into the vena cava (inferior or superior) from any approach with no further manipulation.

The codes you’ll use for nonselective venous catheterization include the following, Gregory says:

• 36000 -- Introduction of needle or intracatheter, vein
• 36005 -- Injection procedure for extremity venography (including introduction of needle or intracatheter)
• 36010 -- Introduction of catheter, superior or inferior vena cava
• 36145
• 36400-36425 -- Venipuncture.

Example: The radiologist documents a unilateral extremity venography. You should report 36005 and 75820 (Venography, extremity, unilateral, radiological supervision and interpretation), Gregory says.

Watch Your Step With Selective -- Here’s Why

You shouldn’t assign nonselective catheter placement codes when the radiologist subsequently performs selective catheterization via the same access route, according to interventional radiology component coding conventions. For example, don’t assign a code for catheter placement in the aorta when the physician goes on to selectively catheterize a branch vessel such as the left common carotid artery.

Watch out: Certain angiography supervision and interpretation codes include abdominal aortography as part of the code definition, so you should carefully read the code descriptor to know for sure before reporting the abdominal aortography.

Example: Selective renal angiography includes any accompanying abdominal aortogram (which is nonselective by definition).

So you should include flush aortogram code 75625 in a selective renal study, such as 75722 (Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation), says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at a Mendota Heights, Minn., clinic.