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Radiology Coding Alert

Untangle Angiogram Reporting by Learning 3 Key Exceptions

Published on Thu Oct 04, 2007

Finally master when to code diagnostic exams separately

Don't let angiograms trip up your radiology claims. As long as you know the bundles and medical-necessity rules to watch for, you'll code angiography services like an ace.


Size Up CCI's Effect on Diagnostic Angiograms

The Correct Coding Initiative (CCI) limits your angiogram coding options, but the good news is that a few of the bundles are fairly obvious.

Example: You can't get paid for both a bilateral renal angiogram (75724, Angiography, renal, bilateral, selective [including flush aortogram], radiological supervision and interpretation) and a unilateral renal angiogram (75722, Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) on the same day. The modifier indicator status is "0," meaning you can never bypass this edit with a modifier.

But other edits are less clear-cut. You have to be certain that you can use a modifier to override the edit and that the documentation supports using one.

Example: CCI bundles a unilateral extremity angiogram (75710, Angiography, extremity, unilateral, radiological supervision and interpretation) into a bilateral extremity angiogram (75716, Angiography, extremity, bilateral, radiological supervision and interpretation). Unlike renal angiograms, however, you can override this edit.

For instance, if your radiologist performs the extremity angiograms during different encounters, you can add modifier 59 (Distinct procedural service) to 75710 -- the lesser-valued code. Also, if your radiologist examines three extremities (both legs, 75716; and one arm, 75710), you can add modifier 59 to 75710, says Sandy Fuller, CPC, compliance officer for a Texas practice.

Remember: Anytime you use modifier 59, you must have documentation to support your choice, says Rehna Burge, billing analyst at North Oaks Medical Center in Hammond, La.

For example, your radiologist must document that he performed these services at different encounters or different locations.

"You can also bill 75716 two times, one for upper extremities and one for lower extremities, but you'll have to appeal it to get paid because most carrier systems will deny it as duplicate," Fuller adds. "But we've been successful on getting these paid upon appeal."


Get the Modifier 59 Lowdown

If you use modifier 59 to override angiogram edits, you should know the rules for using it backward and forward.

CCI bundles 75710 with endovascular repair (75952-75954), stent placement (75960), foreign-body retrieval (75961), peripheral angioplasty (75962), transcatheter biopsy (75970) and atherectomy (75992).

Similarly, CCI bundles 75722 (Angiography, renal, unilateral, selective [including flush aortogram], radiological supervision and interpretation) with endovascular repair (75952-75953), stent placement (75960), foreign-body retrieval (75961), renal/visceral angioplasty (75966), transcatheter biopsy (75970), and renal/visceral atherectomy (75994-75995).

With both code situations, you can use modifier 59 to separate these edits.

First, you can use modifier 59 if your radiologist performs the services during different encounters or on different anatomical sites.

Also, you can use modifier 59 when the angiogram is an initial diagnostic exam and the radiologist bases his decision to perform the intervention on that exam.


Angio-Based Decision? Watch Your Step

If your radiologist performs an intervention due to a diagnostic exam, you'll need to tread carefully.

According to Fuller, CPT instructions state that you should separately report a diagnostic angiography at the time of a transcatheter procedure if:

  • no prior catheter angiogram is available; and
  • the physician performs a full exam; and
  • the physician bases his decision to intervene on the current exam.
  • Again, you must append modifier 59 and include documentation of the decision to intervene in the op report," Burge says.

Example: Your radiologist has no prior films for a patient. He performs a lower-extremity arteriogram, diagnoses superficial femoral artery (SFA) stenosis and decides to perform an angioplasty. Because the diagnostic exam indicated the SFA lesion and was the basis for his decision to perform the angioplasty, you should charge for both the arteriogram (75710-59) and the angioplasty.

Red flag: If your radiologist had a prior catheter angiogram available, you should not report another diagnostic angiogram, Burge says. Keep in mind: You don't have to take into account the time that has passed since the prior angiogram.


Don't Ignore 3 Intervention Exceptions

If the prior catheter angiogram meets one of three exceptions, you can report a second angiogram.

Exception 1: The patient's condition has changed since the prior study. For example, two months ago, an angiogram showed moderate arteriosclerosis in the legs. The patient now returns with the new onset of rest pain and loss of pulses. Because the condition has changed, you can report a new diagnostic angiogram.

Exception 2: The radiologist has inadequate visualization on the prior study. For example, the patient transfers from another facility with poor-quality films. The radiologist cannot make a treatment decision without performing additional imaging. In this case, you can report a new diagnostic angiogram.

Exception 3: The radiologist detects a clinical change during the procedure that necessitates new evaluation outside the target intervention area. For example, imaging during a renal artery stent placement suggests severe stenosis of the superior mesenteric artery (SMA) not seen on the prior exam. The radiologist performs a selective exam of the SMA, which you can separately report.

Source: Examples taken from "Coping With CCI Edits for Peripheral Procedures," presented by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc in Powder Springs, Ga., at The Coding Institute's 2006 Cardiology and Radiology Coding and Reimbursement conference (go to www.codingconferences.com for more information or to obtain a recording of this presentation).

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