Radiology Question for the Week of September 4, 2017

Question:

Would the following scenario code out as an abdominal aortography with bilateral runoff with 75625 and 75716? Or would it be 75630 and 75774 as the department has charged? Selective catheterizations into the arteries were not described.

For a lower extremity revascularization procedure, access with a 5-french sheath was inserted into the right femoral artery and a sequential digital subtraction angiography was performed at multiple levels of the right lower extremity.

Next, a 5-french pigtail was advanced through the sheath over a standard wire into the distal abdominal aorta above the bilateral iliac ostium. From this position, a digital subtraction angiogram was obtained after the distal abdominal aorta.

A glidewire was advanced through the pigtail catheter into the distal left superficial femoral artery (SFA). The pigtail catheter was switched out for a straight tapered glide catheter advanced into the left common femoral artery, and multiple digital subtracted angiograms were obtained of the left lower extremity at multiple levels. Thereafter, endovascular revascularization proceeded.

Answer:

If only the distal aorta was imaged, it would not be reported at all. If the bilateral extremity imaging was ordered and medically necessary prior to the revascularization and a diagnostic interpretation was documented, then you would report 75716–angiography, extremity, bilateral, radiological supervision and interpretation.

The documentation must support a diagnostic angiogram on the same day as a therapeutic procedure. According to the CPT book (Vascular Procedures Subsection, Aorta and Arteries), diagnostic angiography performed at the time of an interventional procedure is separately reportable if:

1.  No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study,

OR

1. A prior study is available, but as documented in the medical record:
   1. The patient’s condition with respect to the clinical indication has changed since the prior study, OR
   2. There is inadequate visualization of the anatomy and/or pathology, OR
   3. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.