Radiology Coding Alert

Question: When performing pelvic angiography, what CPT Code should be used to report the use of ultrasound guidance to access the artery? The actual report reads, Using ultrasound guidance, we accessed the left brachial artery. We placed a 5-French sheath in the left brachial artery

Texas Subscriber

Answer: Three codes would be used to report a pelvic angiogram as described above.

1. Surgical code 36246 (initial second order abdominal, pelvic or lower extremity artery branch, within a vascular family) or 36247 (initial third order or more selective abdominal, pelvic or lower extremity artery branch, within a vascular family) would be used to describe the selective catheter placement in the arterial system. From a brachial approach, a selective pelvic catheterization is either a second- or third-order catheter placement. The common iliac represents the first order and the internal iliac, which can be a selective pelvic, is a second order. Placement beyond that would be third order, but that was not specified in this question.

2. The x-ray portion of the service would be coded 75736 (angiography, pelvic, selective or supraselective, radiological supervision and interpretation).

3. The final code, used to report the ultrasound guidance, will depend on specific carrier guidelines. One of two codes generally would be assigned to describe this service. Code 76942 (ultrasound guidance for needle biopsy, radiological supervision and interpretation) is the description that most closely matches the service performed and it is being accepted by some carriers. Other carriers prefer that radiologists report 76999 (unlisted ultrasound procedure). If your carrier requires the latter, coders will need to include a copy of the physicians report with the insurance claim to describe the service performed.