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Coding Corner: Smooth Your PV Coding Wrinkles

Quick pointers for reporting abdominal and extremity angiographies

If you don't know your physician's catheter placement approach, you'll be out of luck reporting abdominal and extremity angiographies at the same time. Follow these expert suggestions to improve your peripheral vascular procedure coding skills.

Don't Run Off With Extremity Codes

When a physician performs an abdominal angiography, she can perform a "flush aortography" or an "abdominal with runoff" from the same catheter position.

"Flush aortography" in the physician's documentation translates into code 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation).
If you see "abdominal with runoff," you should report 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation).

The difference: Code 75630 includes a runoff study, while 75625 doesn't.
"Runoff" refers to the tendency, in some angiographies, of the dye to run downstream (in the blood vessels) from the location where the physician injected the dye, says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, Minn. 
With the extremity codes, however, you can't bill for any runoff imaging, because there is no different or additional code for such a study, Karl says. As long as the physician keeps the catheter in one place during the procedure, you should report extremity angiographies with one of the following three codes:

75710 - Angiography, extremity, unilateral, radiological supervision and interpretation

75716 - Angiography, extremity, bilateral, radiological supervision and interpretation

+75774 - Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (list separately in addition to code for primary procedure).

Remember that any subsequent studies the physician performs from the same catheter position aren't separately reportable - such as a complete runoff study. The only runoff code you can report is 75630.
Do You Know Where Your Catheter Is?
Reporting an abdominal or extremity angiography is simple enough - but reporting them together presents different challenges.
The key: Know the exact position(s) of the catheter for proper coding, especially to determine whether you can report procedures separately.
If the physician performs imaging of the aorta and runoff vessels from one catheter position in the aorta, you should stick with 75630, says David R. Zielske, MD, an interventional radiology and cardiology coding specialist and president of radiology and cardiology coding publishing company Zhealth Publishing in Nashville, Tenn.
But suppose the doctor images the aorta, for example, and bilateral runoff vessels from one position in the aorta. She performs the aortic imaging in one catheter location, and moves to another to perform the runoff imaging. In this case, [...]

- Published on 2004-04-16