Question:

How would you code when selective renal angiography is performed on the main renal artery (first-order vessel) in the right kidney, then a selective angiogram is performed on a second-order vessel in the left kidney?

Answer:

The complete diagnostic renal angiography code choices only give us options for unilateral/bilateral first-order or second-order or higher vessels. Even though imaging is done bilaterally, the imaging isn’t performed at the same level bilaterally, so you would not report this as a bilateral procedure. You would instead need to report the unilateral first order code (36251) and the unilateral second-order or higher code (36253) with appropriate modifier(s) appended.

36251 Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
36253 Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral
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