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Radiology Coding Alert

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Challenge Yourself With IR Case Study

Published on Sat May 09, 2009

Question: Which CPT codes should I report for the following scenario?

Right common femoral artery was used and a 5 French sheath inserted. I advanced an Omni-flush catheter into the distal aorta and performed an aortoiliac bifemoral angiogram.

Then I passed a wire up and over into the left superficial femoral artery and brought a glide catheter over into the artery and performed a runoff from the SFA down to the feet. Iliac pictures taken on left with an Omni catheter and iliac pictures on right taken through a 5 French sheath. Right leg runoff taken through 5 French sheath.

Utah Subscriber

Answer: Code 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) covers selective cath placement into the left superficial femoral artery (SFA) from the contralateral right approach. There is no separate payment for the catheter position in the aorta; the applicable coding rules assume that nonselective catheter placement in the aorta is "en route" to any selective catheter placements performed from the same access site.

Code 75630: You should report the angiographic study performed from the aorta using 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation). This is because the doctor assessed the abdominal aorta and the iliac and femoral arteries in each leg (the bilateral "iliofemoral lower extremity.")

Code +75774: You also should report the study performed in the contralateral leg (the left leg) with +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [List separately in addition to code for primary procedure]).

This code is supported because the doctor performed an initial study of each leg during the 75630 service; he repositioned the catheter to a different selective position, and then he performed an additional study of the right leg.

The final study performed from the ipisilateral leg (the right leg) was performed non-selectively, through the sheath that was used to facilitate access. Because this position is non-selective, it is not appropriate to report +75774. Its definition specifies that it is a selective study. Because the code structure does not contain a non-selective code that is comparable to code +75774, the best approach is to not separately report the sheath shot described in your scenario.

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