Q & A with Dr. Z: Catheter-Based Angiogram After a Prior Catheter-Based Angiogram, CTA or MRA

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

I read where even though no catheter used CT and MR angiograms are considered catheter based. If a patient has a CT angiogram at 800 and it shows Active contrast extravasation in the pyelocalyceal system in the midpole of the LEFT kidney. Later that day the patient is taken to IVU and has a left renal angiogram, segmental left renal angiogram and embolization. The doctor notes in his dictation the left renal hemorrhage noted on CT angiogram.

In this case I don’t believe the angiogram done by IVU would be billable because the hemorrhage was seen on the CT angiogram. Is that correct? What if CT angiogram done on a Monday for lower extremity but atherectomy done on Wednesday, would the angiograms done in the IVU at that time be billable? The doctor gives detailed findings of each angiogram done. It seems to me that the CT angiogram showed the problem and unless there is a change in the patient condition, the angiograms done in IVU prior to the intervention would not be billable. What if IVU angiograms done a month after CT angiogram?

There is no time limit for repeating a catheter-based angiogram after a prior catheter-based angiogram, CTA or MRA. The reason to repeat a prior study should be either 1) the prior study was not of good quality, was not of the area of interest, was not available for review, had motion or calcification artifact or 2) change in clinical situation or medical necessity or 3) detail is not adequate to fully determine flow dynamics, rapid av shunting, etc. With active bleeding seen on a CTA, I would argue that you may not fully understand the cause (pseudoaneurysm, tumor) of the bleeding and may not be sure which vessel or vessels supply the bleeding site or sites. I would report a catheter-based angiogram in this case.

For a static lesion, such as a stenosis or occlusion of an iliac or fem/pop vessel, I would not report a catheter-based angiogram when the patient comes in for a catheter-based intervention. With cerebral or coronary interventions, the tiny size of the vessels and the clinical significance of not having all the detail necessary to intervene safely requires catheter-based angiography even if a prior CTA. All this can change as CTA’s become more advanced and detailed over the years.


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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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