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Coding Corner: Earn an Extra $175 for Interventional Radiology Coding Know-How

Don't rely on physician's codes

If you're defaulting to the physician's choice of codes when performing interventional radiology in a facility setting, you're probably missing out on substantial reimbursement you deserve. Take this quiz to see if you know when to go with the doctor's flow and when to strike out on your own.
Scenario #1: The physician uses ultrasonic guidance for a patient with adenocarcinoma to drain fluids from her peritoneal cavity. The doctor uses the ultrasound to determine placement of the needle insertion and completes the paracentesis. How should you report these services?
Answer #1: When given this scenario, many facilities would report only the ultrasound code, 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), assuming that because the physician performed the draining, they cannot report the paracentesis code as well. But this assumption is a myth, says C.J. Wolf, MD, CPC, CPC-H, senior consultant at Intermountain Health Care in Salt Lake City. If the doctor performs the radiologic procedure in the hospital with facility equipment, you should bill for it, says Wolf, who presented on interventional radiology at the Third Annual Coding, Billing, and Compliance Essentials Conference in Orlando, Fla. In this case, that means reporting 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) in addition to 76942. Failure to report 49080 will cost your facility at least $175 in reimbursement, and coding and reimbursement guidelines most often let you report for both the procedure code and the imaging guidance code.
Scenario #2: The physician entered the right common femoral artery in order to insert a catheter into the abdominal aorta, which he followed via digital aortography. He then removed the catheter to the distal abdominal aorta, which he followed with step lower-extremity digital runoff arteriography. The documentation states that part of the physician's findings include the following:
The aorta is a little tortuous with mild atherosclerotic irregularity, but no aneurysm. No iliac stenosis is seen. However, there is occlusion at the origin of the left external iliac artery with distal reconstitution of the left common femoral artery via pelvic collaterals ... Left superficial femoral artery is patent, and there is two-vessel runoff via anterior and posterior arteries into the foot. Popliteal artery is patent. Two-vessel runoff into the foot is also noted via anterior and posterior tibial arteries.
How would you code this?
Answer #2: Because the documentation doesn't use the word "extremity" but does use the words "iliac artery" and "femoral artery" in the same sentence, you may be tempted to code these services with 36200 (Introduction of catheter, aorta) and 75630 (Aortography, abdominal plus bilateral iliofemoral [...]

- Published on 2004-01-02