Procedure Practice 11/15/98 - Feature Article 11/15/98
   

Procedure Practice 11/15/98:
Coding Recommendations

  
Listed below are the CPT-4 procedure codes that we think properly classify treatment described. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Suggested Codes and Rationale
   

Procedure #1

Suggested CPT Codes: 36200, 75630, 76350

Rationale: The procedure performed was aortic injection via a femoral approach. Aorta catheterization from any puncture site is a nonselective procedure. Although contrast run-off delineated peripheral arteries in both lower extremities, the catheter itself was not advanced to any other vessels. Therefore, code 36200, Introduction of catheter, aorta, is the correct procedural code assignment. For radiological supervision and interpretation, assign codes 75630, Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography ..., and 76350, Subtraction in conjunction with contrast studies, to capture the digital subtraction component of the radiology services provided.
   

Procedure #2

Suggested CPT Codes: 42550, 70390

Rationale: The physician injected contrast dye into the parotid salivary duct to rule out duct obstruction. Assign code 42550, Injection procedure for sialography, and code 70390,  Sialography, radiological supervision and interpretation, to capture both surgical and radiological components of this procedure.
  

Procedure #3

Suggested CPT Codes: 36200, 36200-51, 35471, 75625, 75625-51, 76350, 76350-51, 75966

Rationale: The physician inserted a pigtail catheter into the aorta via a femoral approach. Reading through the procedure note carefully, we see that the pigtail catheter was inserted into the aorta on two separate occasions: once to highlight the renal arteries before the angioplasty and again following the angioplasty. Digital subtraction angiography was performed in conjunction with each of these two contrast procedures. Assign codes 36200 and 36200-51 for the aortic catheterizations (Introduction of catheter, aorta, two separate catheterizations); 75625 and 75625-51 for the radiology supervision and interpretation of the catheterizations (Aortography, abdominal, by serialography, radiological supervision and interpretation, two separate procedures); and 76350 and 76350-51 for the DSA components of each catheterization (Subtraction in conjunction with contrast studies; two separate studies).

NOTE: Do not be misled by the procedure heading "bilateral renal angiograms" in the procedure title. Remember that the final position of the catheter determines the correct code. Arteries visualized by an injection performed in the aorta are not considered selective catheterizations.

The physician performed a right renal transluminal angioplasty by inserting a balloon tip catheter into the right renal artery to dilate it. Code the renal angioplasty 35471, Transluminal balloon angioplasty, percutaneous; renal or visceral artery, and 75966, Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation.

Procedure Practice 11/15/98 - Feature Article 11/15/98