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With as much as 10-30 percent of coding lost in errors and rendered inaccurate, now is a good time to review interventional radiology coding. Even more, radiology has experienced the great resignation, with a turnover in labor, with many facilities likely having brand new eyes and minds focused on coding. These combined factors make accurate coding for interventional radiology services all that more crucial and a review of the guidelines even more necessary. 

Nonselective Coding vs. Selective Coding

Understanding the nuances of nonselective vs selective coding is an important component for knowledge foundation. For nonselective coding use code 36200 should always be used to describe aortic access via axillary, brachial or femoral approach. Always use code 36160 to describe aortic access via translumbar approach.

For selective coding one question that may occur is how to code for the study of two or more vascular families. When studying two or more vascular families, code each separately. When circumstances permit, you should code to the highest order of selectivity within each vascular family. Understand that bronchial/intercostal arteries are considered to be thoracic/brachio cephalic arteries.

In the scenario that you are imaging more than one second- or third-order vessel in a single vascular family, code to the highest order. Following this, it is important to recognize additional second- or third-order branches within that family with code 36248.

Radiological Supervision and Interpretation Coding Tips

Under the circumstances when performing an arteriogram with the catheter in the upper abdominal aorta and studying the full abdominal aorta and lower extremity vessels (bilaterally, at least through the level of the femoral arteries) in one fluid exam, submit the single S&I code 75630.

If performing separate full and complete exams of both the abdominal aorta and lower extremity vessels, code separately each anatomic area imaged, using codes 75625 and 75716 or 75710. Normally, this is accomplished by separate nonselective catheter placements, both high (typically at the renal arteries level) and low (catheter at the aortic bifurcation).

Understand that code 75726 includes the flush aortography procedure. It is important to know that you should not bill separately for aortography (75625) when performing these studies.

You should only submit code 75774 when performing additional selective catheterizations after the basic study. What are other circumstances where this code should not be used? Do not use this code when performing extra views, extra runs, obliques, etc. when the catheter is not selectively advanced into another vessel after the primary procedure. Code 75774 should not be used for routine “completion” angiography performed on every study. Use this code only when there is true need for additional diagnostic imaging after the basic/primary study. Always remember that physician documentation is crucial to coding. Physician documentation should clearly state the medical necessity for this additional selective imaging.

Selective renal arteriography is coded with complete procedure codes describing unilateral or bilateral first-order studies and unilateral or bilateral second-order or higher studies. Know that each code includes catheter placement(s) and radiological supervision and interpretation. Accessory renal arteries are included and not coded separately. Flush aortography (75625) is also included in 36251–36254 and not coded separately.

The abdominal arterial system is a common site of many anomalous arterial locations. The procedural report must be read carefully to determine correct coding. Arteries may arise from the aorta instead of more common locations or may be “replaced” from one vascular family to another (e.g., a replaced right hepatic artery is generally a branch of the SMA instead of the celiac artery).

These are not all the necessary coding tips and rationale essential for correct abdominal angiographic and abdominal coding and compliance. As service volumes rebound, now more than ever it is imperative to make sure your CPT® coding is correct and compliant. Master more interventional radiology topics and break down the complexity with expert-infused insight. Our Abdominal Interventional Radiology Coding webcast is an essential training tool for both audio and visual learners.

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