Radiology Coding Alert

It's not enough for coders reporting pulmonary angiography studies to know only the proper code assignments within the pulmonary system. For full reimbursement, coders must also understand unique service situations when they may report venous system codes as well. During a PA, "radiologists advance the catheter through the venous system to access the pulmonary system," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices in Chattanooga, Tenn. "On occasion, the radiologist stops in the vena cava and performs an inferior vena cavagram. When this occurs, you would assign additional codes."

Typically, the radiologist accesses the venous system at the groin and advances the catheter to the inferior vena cava. Images may be obtained to allow visualization of the blood flow from the renal vein. If completed and documented, Hall says, coders should assign 36010 (Introduction of catheter, superior or inferior vena cava) with CPT 75825 (Venography, caval, inferior, with serialo-graphy, radiological supervision and interpretation). "Remember, however, that if the radiologist doesn't actually stop here and take the images, these codes can't be used," she warns. Advancing Into the Main Pulmonary Artery From this point, the radiologist moves the catheter further into the system to access the main pulmonary artery. If the radiologist stops the catheter within this vessel, angiography is reported with CPT 36013 (Introduction of catheter, right heart or main pulmonary artery) and 75746 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation). Selecting Right/Left Branches In other cases, the radiologist may advance into the right and/or left branches of the pulmonary artery, says Donna Gullikson, CPC, division director for Medical Computer Business Systems, a national coding and billing company based in Augusta, Ga. This scenario is coded with 36014 (Selective catheter placement, left or right pulmonary artery). If both the left and right sides are catheterized, report 36014 twice. Depending on payer preference, you would assign modifier -50 (Bilateral procedure) to the second occurrence of the repeated code or add the RT/LT designation.

Gullikson adds that you should choose one of two radiological supervision and interpretation (RS&I) codes for angiography of the right and left pulmonary branches. If angiography is performed only on one side, use 75741 (Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation). "If images are obtained from both sides, use 75743 (Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation)," she says. Coding Further Artery Selection The radiologist may progress further into the pulmonary system, selecting arteries that branch into the upper, middle or lower lobes of the lung. "This additional selection is described in 36015 (Selective catheter placement, segmental or subsegmental pulmonary artery)," Hall says. "You can [...]