Radiology Coding Alert

When your radiologist pairs with a vascular surgeon to perform endovascular abdominal aortic aneurysm repair, you have to take a shared approach to coding, too. Work your way through this sample procedure to see if you can spot where you should and shouldn't stake your claim.

In a typical two-physician procedure, the surgeon performs the cut-down exposure of the common femoral arteries. For this work, the surgeon -- not the radiologist -- would assign 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral) for each access made, says Jolynn Van Ert, ARRT, CPC, CIRCC, radiology support specialist with Luther Midelfort hospital and clinic in Eau Claire, Wis.

The radiologist then places sheaths in a retrograde manner. Via these sheaths, the radiologist then places catheter(s) into the aorta and performs abdominal arteriography to locate and verify the endograft's intended landing zone.

CPT considers this aortography bundled into the endovascular aneurysm repair (EVAR), so you should not report the aortography separately, says Van Ert.

Coding point: You may report 36200 (Introduction of catheter, aorta) to represent the radiologist's placement of the catheter into the aorta. Be sure to verify that the radiologist performed and therefore may code this procedure. And if she places bilateral catheters, follow your payer's preference for reporting the service, such as reporting the code twice or appending modifier 50 (Bilateral procedure).

Following catheterization, the surgeon and radiologist work together to place and deploy the endograft. Often this is a modular bifurcated prosthesis with one docking limb, Van Ert says.

Coding point: The radiologist should report this team effort by appending modifier 62 (Two surgeons) to the appropriate prosthesis code. For the commonly used modular bifurcated prosthesis with one docking limb, for example, report 34802 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [one docking limb]),  Van Ert says.

Tip: When considering modifier 62 use, treat each physician's portion as a separate procedure that requires a separate operative note, says Beth Thomsen, department billing coordinator at University of Toledo Physicians in Ohio. The sum of these two op notes equals the one CPT code both physicians are submitting. For more information, see "Count on MPFS Co-Surgery Column for Proper 62 Use" on page 11.

Next step: Following deployment of the body and subsequent docking limb, the radiologist routinely "tacks" the endograft into place using balloon angioplasty. You should not report this angioplasty separately if the radiologist performs it within the "target zone" of the endoprosthesis.

If an extension prosthesis (proximal or distal) is needed, the surgeon and radiologist may jointly perform the procedure.

Coding point: You should report 34825 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm or dissection; initial vessel) for the initial vessel and +34826 (... each additional vessel [List separately in addition to code for primary procedure) for each additional vessel, Van Ert says. Append modifier 62 to each because both physicians performed the procedure.

The radiologist typically both supervises and interprets the images taken during the exam, Van Ert says.

Coding point: For these services assign 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation) and 75953 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation) as documented, Van Ert says. Remember to append modifier 26 (Professional component) when appropriate.

Coding roundup: For the sample EVAR case discussed above, performed by both a radiologist and vascular surgeon, your final claim for the radiologist may include the following codes:

• 36200 for catheter placement in the aorta (code twice if bilateral)

• 34802-62 for co-surgeon placement of prosthesis

• 34825-62 for co-surgeon placement of initial vessel extension prosthesis and +34826-62 for each additional vessel

• 75952-26, 75953-26 for RS&I, depending on documentation.