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Coding Corner: Case Study: Choose Catheter Codes With Care

Determine selective or non- to avoid bundling

If you're having trouble deciding when you need a surgical code, when you need a radiology code, and when you need both, practice your interventional radiology coding skills by coding this real-life case study.
Procedure: The physician prepares left groin in sterile fashion. He inserts a 5-French sheath into the left common femoral artery. He advances the wire to the abdominal aorta and over the wire, inserts a 4-French Tennis Racquet catheter and then performs a diagnostic angiography.
The nurse administers 6000 units IV heparin. Doctor performs balloon dilation of the left external iliac artery using a Synergy 8 x 20-mm balloon. Doctor removes balloon and crosses over the right common iliac artery with a 5-French 65-cm Imager II contralateral catheter. He then exchanges the 6-French short sheath over a wire for a 6-French 65-cm Arrowflex sheath, and re-advances the Synergy balloon over the aortic bifurcation. Doctor performs a balloon dilation of the right common iliac artery.
He removes the balloon and places an Express stent in the right common iliac artery. Doctor removes the delivery balloon, reinserts the Tennis Racquet catheter, and performs a post-intervention angiography. Re-moves Tennis Racquet catheter.
Know When to Code 'Em
The physician performs several parts of the operation before he performs any separately reportable services, so evaluate the whole operative report carefully before assigning codes.
First, he punctures the left common femoral artery, which is included in the code for the catheterization. Then he advances the catheter to the abdominal aorta, but if you read on, you'll see that the catheterization was selective - which includes non-selective catheterization, says Kristi Stanton, RHIT, CCS, CPC, nosologist and coding training specialist at Integrated Revenue Management Inc. in Carlsbad, Calif. So the initial catheter advancement will be included in the code for the selective catheterization.
The clue to signal your first code assignment: "diagnostic angiography." Because the physician used runoff to image the vessels of the patient's lower extremities, you should report this part of the operative session with 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation), Stanton says.
Include Both Components for Dilation
Next, you'll need to describe the dilation of the left external iliac artery. Don't forget that you need to report two codes for this - one to cover the surgical component and the other to describe the radiological interpretation, Stanton says. For the surgical component, you'll report 35473 (Transluminal balloon angioplasty, percutaneous; iliac). For the radiology component, you'll report 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation).
Focus On Order and Selectivity for Cath Code
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- Published on 2005-05-17