Question: A recent radiology report indicated that the radiologist entered the right common femoral artery and performed an abdominal aortogram with runoff. A left common iliac artery stenosis was discovered, so the radiologist proceeded with PTA and stenting. The radiologist accessed the left common femoral artery and successfully manipulated across the stenosis. Should I code for both access points?
Answer: Yes, you should code for both access points the right and the left common femoral artery. Specific coding would depend on how far the radiologist advanced the catheter. Usually when a percutaneous transluminal angioplasty (PTA) is performed on the common iliac artery, the radiologist guides the catheter through the stenosis into the lower abdominal aorta. In this case, code 36200 (Introduction of catheter, aorta) should be assigned to both catheterizations. The code should be reported twice, with the appropriate bilateral modifier (i.e., modifier -50 appended to the second instance of 36200 or the RT/LT designation with one of these assigned to each instance of 36200).
The PTA is reported with 35473 (Transluminal balloon angioplasty, percutaneous; iliac). If the PTA is done and the radiologist then decides to place the stent based on the post-PTA angiogram and/or hemodynamic measurements, you can bill for both the PTA and stent placement (37205, Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel). However, if angioplasty balloon inflation is performed simply to deploy the stent, you can bill only for the stent.
Radiological supervision and interpretation (RS&I) codes are assigned along with these surgical codes. CPT 75630 (Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation) accompanies the initial intra-arterial procedure (36200). 75630 would be reported only once. Alternatively, if the non-selective catheter was repositioned after the aortogram and prior to the bilateral lower extremity angiogram, two RS&I codes would be used: 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) and 75716 (Angiography, extremity, bilateral, radiological supervision and interpretation). If you determine you can report the PTA, 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation) may also be used. Finally, 75960 (Transcatheter introduction of intravascular stent[s] [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel) is reported with 37205.