By C. Matthew Hawkins, MD Fall 2018
SIR thanks C. Matthew Hawkins, MD, for serving as the Coding Q&A columnist for the past three years. His long-time contributions to IR Quarterly are greatly appreciated!
Q How does one report provision of diagnostic and therapeutic interventional radiology services at the same session?
A One must clearly delineate between diagnostic RS&I services and RS&I services provided during the therapeutic intervention.
Pages 460–461 of the 2018 CPT® Professional Edition describes in detail the scenarios in which diagnostic angiograms are billable with transcatheter therapies. In general, it would be considered appropriate to bill for the diagnostic angiography in the following scenarios: 1) no prior or recent study is available to guide therapy, 2) the patient’s condition has changed, 3) the treatment plan may be affected, 4) other vessels may be identified for treatment or 5) further establishment of a diagnosis from a noninvasive study is necessary.
In these scenarios, a –59 modifier should be added to the diagnostic services to identify them as a distinct service. All services should be documented in the patient’s written record. Therefore, the exact nature of the procedural (surgical) services should be clearly delineated. If services are combined into one report, the individual types of services (surgical, radiological, management) should be clearly separated and identified in the body and impression of the report. Alternatively, separate reports may be generated for each of the services.
Q Is abdominal aortogram, CPT 75625, included in the visceral angiography codes for the celiac and superior mesenteric arteries?
A Yes, an abdominal aortogram (75625) is included in visceral angiography when it is performed and is not separately reportable.
75726 angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation.
Q How do I code for selection and performance of angiograms of celiac artery (1st order), common hepatic artery (2nd order), right hepatic or left hepatic artery (3rd order), and subselective arteriography (beyond)? The CPT codes for visceral angiography are 36245–36248. If I select and document arteriography for each successive artery, do I code for each or just the highest level?
A Selective and supraselective catheterization codes include catheterization of lesser-order branches in the same vascular family. The hepatic arterial system is considered a “vascular family” with the parent being the celiac artery. Assuming all vessels were selectively catheterized, and injections were made in each vessel (celiac, common hepatic, right or left hepatic, and supraselective branches) in the same session, one 3rd-order code (36247) plus one visceral angiography S&I code (75726) are reported for this service. The add-on CPT code 75774 would be reportable for the additional selective angiograms if they are diagnostic in nature and supported in your documentation. The add-on CPT code 36248 is used when additional 2nd- or 3rd-order branches are selected within the same vascular family. For example, if you selected the right and left hepatic branches, then 36247 and 36248 would be reportable. The number of times 36248 and 75774 can be reported together depends on the actual number of vessels selectively catheterized, injected and documented both in the medical record and in the image archive. Note that documentation of the catheterization includes description of the catheter location in the operative note and the S&I includes imaging archival and an interpretation of the angiographic images (description of what the angiographic images demonstrated) in the medical record. If either documentation requirement is absent, then the respective code may not be reported.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2017/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service.
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