Radiology Coding Alert

Pay attention:  Not every procedure follows the normal treatment path

Interventional radiology reports offer up a triple challenge: multiple anatomic areas, numerous steps, and combinations of surgical and RS&I codes. Make sure you're ready for the next procedure note that lands on your desk with this detailed look at coding a PTA (percutaneous transluminal angioplasty).

Good idea: Read the full report on later in this issue and determine which codes you would use before reading our expert's solution.
 
Take the Report Step-by-Step We've broken down the procedure note into sections to walk you through the correct coding.

History: "A 73-year-old male with insulin-dependent diabetes and heart disease had a percutaneous transluminal coronary angioplasty (PTCA) three years ago. He now has drug-resistant hypertension, and noninvasive testing indicates probable renal artery stenosis." 

Part 1: "Physician draped and prepped right groin area and introduced a pigtail catheter to the aorta through a retrograde right common femoral artery puncture. Then performed a flush abdominal aortogram."

Solution: Your catheter placement at this point merits 36200 (Introduction of catheter, aorta), says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at a clinic in Mendota Heights, Minn.

But you need to read the full report before you commit to this code.

Reason: According to interventional radiology component coding conventions, you should include nonselective catheter placement codes in subsequent selective catheterizations codes if they're performed via the same access route. You won't report 36200 because there's a selective renal catheter placement later in the report.

You're also going to include the flush aortogram (75625, Aortography, abdominal, by serialography, radiological supervision and interpretation) in the selective renal study the physician performs later, Karl says.

Why? Certain RS&I codes include nonselective aortogram services within the selective catheterization code--carefully read the code descriptor to know for sure. Selective renal angiography includes any accompanying nonselective aortogram.

Tip: Make a presumptive coding list now, but don't assign your final code choices yet.
 
Part 2: "The initial study of the right and left renal systems revealed potential high-grade stenosis of the mid-left renal artery, while the right renal arterial system looked essentially normal with no focal stenoses. This was consistent with previous noninvasive testing. The physician then performed a left renal arteriogram using a curved catheter by way of a left renal artery cannulation. Selective diagnostic study of the left renal artery confirmed a high-grade preocclusive stenosis suggestive of fibromuscular dysplasia (FMD). The right renal artery was only visualized from the flush abdominal aortogram. The artery and its branches were within normal limits, as noted previously."

Solution: "Here we have the selective left renal artery catheter placement (36245, Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family) and selective unilateral renal study 75722-26-59 (Angiography, renal, unilateral, selective [including [...]