Q & A with Dr. Z: Lower Extremity Angiogram Codes


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

Question:

Angiogram (DSA) of the entire left lower extremity and iliac arteries using a 4-French x 45 cm long Rim catheter advanced from the right common femoral artery up and over and down into the left SFA. Selective angiogram of the left Posterior Tibialis, peroneal, and Anterior Tibial using a 4 Fr x 150 cm long Navicross catheter advanced from the right common femoral artery -up and over the left lower extremity. Please confirm use of the correct codes. 36247, 36248, 76937-26, 75710-26.

Answer:

IF the catheter was actually advanced into the AT, PT and Peroneal arteries, you would get catheter placements 36247 and 36248 x 2. If the imaging was actually done from the SFA, the catheter placement would be only 36247. Imaging is 75710 for the initial complete extremity angiogram. If the catheter was then advanced into the three TP trunk vessels for additional imaging (not completion) of the three separate branches, code 75774 would be reported x 3.

IF the MD went on to fix any blockage in the same lower extremity via the same access, all these catheter placements would be bundled and the imaging codes would require -59 modifiers to show they were diagnostic (and not just for guidance).

IF only for guidance, all imaging codes would be non-reportable as well.

 

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About the Author

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