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Coding InterventionalRadiology ServicesAudio Seminar/WebinarMarch 20, 2008Practical Tools for Seminar Learning Copyright 2008 American Health Information Management Association. All rights reserved.
DisclaimerThe American Health Information Management Association makes norepresentation or guarantee with respect to the contents herein and specificallydisclaims any implied guarantee of suitability for any specific purpose. AHIMA hasno liability or responsibility to any person or entity with respect to any loss ordamage caused by the use of this audio seminar, including but not limited to anyloss of revenue, interruption of service, loss of business, or indirect damagesresulting from the use of this program. AHIMA makes no guarantee that the useof this program will prevent differences of opinion or disputes with Medicare orother third party payers as to the amount that will be paid to providers of service.CPT five digit codes, nomenclature, and other data are copyright 2007 AmericanMedical Association. All Rights Reserved. No fee schedules, basic units, relativevalues or related listings are included in CPT. The AMA assumes no liability for thedata contained herein.As a provider of continuing education, the American Health InformationManagement Association (AHIMA) must assure balance, independence, objectivityand scientific rigor in all of its endeavors. AHIMA is solely responsible for control ofprogram objectives and content and the selection of presenters. All speakers andplanning committee members are expected to disclose to the audience: (1) anysignificant financial interest or other relationships with the manufacturer(s) orprovider(s) of any commercial product(s) or services(s) discussed in an educationalpresentation; (2) any significant financial interest or other relationship with anycompanies providing commercial support for the activity; and (3) if thepresentation will include discussion of investigational or unlabeled uses of aproduct. The intent of this requirement is not to prevent a speaker withcommercial affiliations from presenting, but rather to provide the participants withinformation from which they may make their own judgments.The faculty has reported no vested interests or disclosures regarding thispresentation.AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reservedi
FacultyStacie L. Buck, RHIA, CCS-P, LHRM, RCCStacie has served in several different roles during her 14-year career in health informationmanagement including as a medical records coordinator, medical coder, a revenue analyst, aninternal auditor, corporate compliance officer, and consultant. Stacie is currrently VicePresident for Southeast Radiology Management.Stacie is on the editorial advisory board for the HCPro newsletters Mammography RegulationReport, Radiology Administrator’s Compliance Insider, Health Care Auditing Strategies and sheis a frequent contributor to Strategies for Health Care Compliance and to Compliance Monitor Q& A’s Ask the Expert. In addition, she is the author of the recently released RadiologyTechnologist’s Coding Compliance Handbook and is a Contributing Editor for The RadiologyManager’s Handbook: Tools & Best Practices for Business Success. Stacie also is anaudioconference presenter for HCPro, the Coding Institute and the American HealthInformation Management Association (AHIMA).Stacie is an adjunct instructor and advisory board member for the health informationmanagement program at Indian River Community College in Florida and she serves in theAHIMA Mentoring program. Recently Stacie was the recipient of several awards including the2005 AHIMA Rising Star Award, FHIMA Outstanding Professional Award & FHIMA LiteraryAward.Stacie is a current member of the American Health Information Management Association(AHIMA), the Florida Health Information Management Association (FHIMA) and the SuncoastHealth Information Management Association (SHIMA). She serves on the AHIMA PhysicianPractice Council and is President-Elect of the Florida Health Information ManagementAssociation.Stacie graduated Magna Cum Laude from Florida International University earning a Bachelor ofScience degree in Health Information Management and prior earned an Associate of Artsdegree in Business AdministrationAlicia Franklin, RHIA, CCS-P, RCCAlicia has over 10 years experience in the healthcare environment, including health informationmanagement experience in ICD-9-CM and CPT coding for inpatient and outpatient settings.She has worked in areas of HIPAA Compliance, Coding Specialist, and Charge MasterCoordinator for The University of Mississippi Medical Center, and has been a Coding Consultantwith a previous accounting firm.As a member of the BKD Health Care Group, Alicia provides consulting services for hospitalsand physician offices on coding, billing, and medical staff documentation. She also providescoding education, support to medical staff, and other billing and healthcare personnel.With a Bachelor of Science degree in Health Information Management from The University ofMississippi Medical Center, Jackson, Alicia is a Registered Health Information Administrator(RHIA), Certified Coding Specialist – Physician Based (CCS-P) and a Radiology Certified Coder(RCC). Alicia is a member of the American Health Information Management Association(AHIMA) and the Healthcare Financial Management Association (HFMA).AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reservedii
Table of ContentsDisclaimer . iFaculty .iiSeminar Objectives . 1Component Coding. 1All Inclusive Coding . 2Vascular System. 3Key Documentation . 3Access . 4Vascular Family. 4Vascular Order . 5Non-Selective Catheterization. 5Selective Catheterization. 6Non-Selective Catheterization Codes – Arterial . 6Selective Catheterization Codes – Arterial . 7Non-Selective Venous Codes . 8Selective Venous Codes . 8Catheterization Coding Rules. 9Multiple Vascular Families . 9Additional Branches in Same Family .10RS&I Coding .10Modifiers .11 75774 .11Head and Neck Angiography .12Examples.12Upper Extremity and Example .14Lower Extremity/Pelvic Angiography.15Catheter Placement Aorta and Examples .15Abdominal Angiography and Example.17Venous RS&I Codes.18Vena Cavagram and Examples.19Therapeutic Interventions .21Diagnostic Angiography Coding Rules w/Therapeutic Interventions.21Medicare (NCCI).23Transcatheter RS&I Codes .25Angioplasty Coding Rules .25PTA .26PTA RS&I Codes and Examples.26Atherectomy Coding Guidelines .27NCCI Manual.28Transluminal peripheral atherectomy, percutaneous; .28RS&I Codes and Examples .29Stent Coding Rules .30Peripheral Stent Placement .30AHIMA 2008 Audio Seminar Series
Table of ContentsCervical Carotid Stents .31Intracranial Stents .31Extracranial Vertebral or Intrathoracic Stents and Example .32Embolization and Occlusion Coding Guidelines .33RS&I .34Uterine Fibroid Embolization and Examples .34Infusion Therapy Coding Rules .36Thrombolysis and RS&I.37Percutaneous Arterial Thrombectomy .38Primary Thrombectomy.38Secondary Thrombectomy.40Percutaneous Arterial Thrombectomy .41Percutaneous Vein Thrombectomy and Examples .41IVC Filter Placement .43Foreign Body Retrieval (Filter Removal) and Examples.43Dialysis Access Maintenance.44DAM – Catheterization .45DAM – Fistulagram .45DAM – Thrombectomy .46DAM – Percutaneous Angioplasty and Examples.47Audience QuestionsAppendix.53CE Certificate Instructions .54AHIMA 2008 Audio Seminar Series
Coding Interventional Radiology ServicesNotes/Comments/QuestionsObjectives of this Seminar Review clinical issues and CPT coding guidelinesfor interventional radiology specific to concepts invascular catheter placements and diagnosticangiography.Discuss the differences between diagnosticradiology codes and therapeutic interventionalradiology codesProvide coding guidance for modifier usage withinterventional radiology proceduresReview CPT coding guidelines related to vascularproceduresDeliver challenging case scenarios that illustratebest coding practices.1Component Coding May or may not have a 1:1 ratioSurgical codes Vascular access Catheter placement InterventionsRadiological supervision and interpretation Imaging (guidance and images taken) Interpretation of films Physician must supervise and interpret Append Modifier -52 if only one portion of serviceprovided Hospital coding – report S & I whether performed bysame or different physiciansAHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved21
Coding Interventional Radiology ServicesNotes/Comments/QuestionsWhy Component Coding? Multiple physicians performing procedure Surgeon, radiologist Physician would code only the servicehe/she providedVariations in how services are performed Patient’s specific anatomy, pathology,and other clinical circumstances.Variety of combinations for proceduresperformed.3All Inclusive Coding IR services commonly performed by anindividual physician, in a consistentmanner with little or no variation.Services are reportable usinga single code, inclusive ofboth procedural andimaging services. Examples: 37210, 616234AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved2
Coding Interventional Radiology ServicesNotes/Comments/QuestionsVascular System Five vascular systems forinterventional procedures: ArterialVenousPulmonaryPortalLymphaticEach system is coded separately5Key Documentation Catheter insertion pointCatheter end positionVessels catheterizedVessels visualizedAbnormal anatomy6AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved3
Coding Interventional Radiology ServicesNotes/Comments/QuestionsAccessSite where physician enters thevascular system by puncturing avessel Catheterization codes are selectedbased on access site Multiple access sites and theircatheterizations are reportedseparately 7Vascular Family Group of vessels that arise from aprimary branch Network of vessels that arise from asingle branch from the aorta or venacava Network of vessels that arise from theaccess site8AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved4
Coding Interventional Radiology ServicesNotes/Comments/QuestionsVascular Order First Order Vessel that is a primary branchoff the aorta or vena cava Second Order Vessel branching from afirst order vessel Third Order Vessel branching from asecond order vessel9Non-Selective Catheterization The catheter or needle is placeddirectly into an artery or vein (andnot moved or manipulated further)or is negotiated only into the aorta(thoracic and/or abdominal) fromany approach.10AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved5
Coding Interventional Radiology ServicesNotes/Comments/QuestionsSelective Catheterization Movement of the catheter into thearterial (or venous) system beyondthe aorta (or vena cava) or vesselpunctured.11Non-Selective CatheterizationCodes – Arterial 3620036100 36120 36140 36145 36160 Introduction of catheter, aortaIntroduction of needle or intracatheter,carotid or vertebral arteryIntroduction of needle or intracatheter;retrograde brachial arteryIntroduction of needle or intracatheter;extremity arteryIntroduction of needle or intracatheter;AV shunt created for dialysisIntroduction of needle or intracatheter;aortic, translumbar12AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved6
Coding Interventional Radiology ServicesNotes/Comments/QuestionsSelective Catheterization Codes –Arterial 36215Selective catheter placement, arterialsystem; each first order thoracic orbrachiocephalic branch, within avascular family36216 initial second order36217 initial third order or more selective 36218 additional second order,third order, and beyondThese codes are used for procedures above the diaphragm.13Selective Catheterization Codes –Arterial 36245Selective catheter placement, arterialsystem; each first order abdominal,pelvic or lower extremity artery,within a vascular family36246 initial second order36247 initial third order or more selective 36248 additional second order,third order, and beyondThese codes are used for procedures below the diaphragm.14AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved7
Coding Interventional Radiology ServicesNotes/Comments/QuestionsNon-Selective Venous Codes 36000 Introduction of needle orintracatheter, vein36005 Injection procedure forextremity venography36010 Introduction of catheter,superior or inferior vena cava36299 Unlisted procedure, vascularinjection15Selective Venous Codes36011 Selective catheter placement,venous system; first orderbranch 36012 Selective catheter placement,venous system; second order,or more selective 16AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved8
Coding Interventional Radiology ServicesNotes/Comments/QuestionsCatheterization Coding Rules Code selective over non-selectiveCode each vascular family to the highestorder selected.Each vascular access is coded separately.Additional vascular families catheterizedare coded separately.17Multiple Vascular Families Each family is coded separately when twoor more vascular families are catheterized.An initial catheter placement code isassigned for each vascular family.Add on codes are also assigned for eachfamily as needed.18AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved9
Coding Interventional Radiology ServicesNotes/Comments/QuestionsAdditional Branches in Same Family Only 1 initial catheter placement code canbe reported per vascular family. Catheter may be pulled back and advancedinto a different branch within the samefamily. Code (36218 or 36248) (36012) for thelower of the two placements in addition tothe highest catheter placement code in thefamily 36218 and 36248 may be assignedmultiple times.19RS&I Coding Contrast is injected for imaging of vesselsBoth unilateral and bilateral codesSome codes specify selective imagingRS&I codes are assigned for each vesselstudiedIf a higher order branch is studied andthere is no CPT code to describe that study,use 75774 (add on code)20AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved10
Coding Interventional Radiology ServicesNotes/Comments/QuestionsModifiers Do NOT use -50 or RT/LT withcatheterization codes. (Medicare) Utilize modifier -59 to indicateseparate vascular families. RS&I codes – RT/LT or -59 whenapplicable21 75774 Assigned for smaller vessels that have noimaging codesPhysician interprets a vessel and thenselects an additional branch of that vesselfor additional study and interpretation.Do not use for additional injection/imagingof same vessel!22AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved11
Coding Interventional Radiology ServicesNotes/Comments/QuestionsHead and Neck Angiography75650 Cervicocerebral (aortic arch study)75660 External carotid, selective, unilateral75662 External carotid, selective, bilateral75665 Carotid, cerebral, unilateral (internal carotid)75671 Carotid, cerebral, bilateral (internal carotids)75676 Carotid, cervical, unilateral (common carotid)75680 Carotid, cervical, bilateral (common carotids)75685 Vertebral, cervical and/or intracranial(basilar)75756 Internal mammary 75774 Selective, each additional vessel studiedafter basic exam 23Example Access: Right common femoral.Catheter advanced to aortic arch, contrast injected for archimaging. Catheter then advanced to RCC, contrast injectedfor imaging of RCC, RIC, and REC. Catheter advanced intothe LCC, contrast injected for imaging of LCC, LIC, LEC.36216 (RCC)36215-59 (LCC)75650 (arch study)75671 (LIC & RIC)75680 (LCC & RCC)Note: Imaging of REC & LEC was performed from a nonselective injection. External carotid imaging requiresselective catheterization of the external carotids.24AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved12
Coding Interventional Radiology ServicesNotes/Comments/QuestionsExample Access: Right common femoral.Catheter advanced to RCC, contrast injected for imaging ofRCC, RIC. Catheter advanced to the R Vertebral for injectionand imaging. Catheter advanced into the LCC, contrastinjected for imaging of LCC, LIC. Catheter advanced to the Lvertebral with injection and imaging.36216 (RCC)36218 (R Vertebral)36215-59 (LCC)36215-59 (L Vertebral)75671 (LIC & RIC)75680 (LCC & RCC)75685-LT (vertebral)75685-RT (vertebral) Note: Imaging of REC & LEC was performed from a non-selective injection. External carotid imaging requires selective catheterization of the external carotids.25ExampleAccess: Right common femoral. Catheter advanced to RCC, contrast injected forimaging of RCC, RIC. Catheter advanced into the REC,with injection and imaging, then catheter is advancedinto maxillary for injection and imaging. )(maxillary)26AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved13
Coding Interventional Radiology ServicesNotes/Comments/QuestionsUpper Extremity Angiography 757107571675658Angiography, extremity, unilateral, RS&IAngiography, extremity, bilateral, RS&IAngiography, brachial, retrograde, RS&I27Example Access: Right common femoral arteryCatheter advanced to both the right and leftsubclavians, which are selectively catheterizedwith injection and imaging. 36216 (R Sub) 36215-59 (L sub) 7571628AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved14
Coding Interventional Radiology ServicesNotes/Comments/QuestionsLower Extremity/Pelvic Angiography 75625 75630 757107571675736 75774 Aortography, abdominal, by serialography,RS&IAortography, abdominal plus bilateralilieofemoral lower extremity, catheter, byserialography, RS&IAngiography, extremity, unilateral, RS&IAngiography, extremity, bilateral, RS&IAngiography, pelvic, selective orsupraselective, RS&ISelective, each additional vessel studied afterbasic exam29Catheter Placement Aorta Single catheter placement, injectionin aorta, contrast flows into lowerextremities – “runoff” 36200 and 75630 Two catheter placements – injectionin abdominal aorta, catheterrepositioned in lower aorta for alower extremity study 36200, 75625, 7571630AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved15
Coding Interventional Radiology ServicesNotes/Comments/QuestionsExampleAccess: Right common femoral. Catheter is advanced into the aorta contrast is injectedfor aortogram. Catheter is pulled down into the distalaorta, contrast injected for bilateral lower extremityrun off study. 36200 (aorta) 75625 (aortogram) 75716 (bilateral extremity)31Example Access: Axillary ArteryCatheter advanced to aorta, contrast injected with imaging.Catheter advanced to the right common iliac, contrastinjected with imaging of the right lower extremity andright internal iliac. 36245 (R C Iliac) 75625 (Aortogram) 75710 (RLE)Access: Axillary ArteryCatheter selectively advanced to the bilateral internal iliacsand bilateral uterine arteries with contrast injection andimaging. 36247 (RUA) 75774 (RUA) 36247-59 (LUA) 75774 (LUA) 75736-RT (R Iliac) 75736-LT (L Iliac)32AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved16
Coding Interventional Radiology ServicesNotes/Comments/QuestionsAbdominal Angiography 75625Abdominal, by serialography (use forvisualization of renal and/or visceralvessels from an injection of theaorta–when no selective imaging)75630Abdominal w/ bilateral ileofemoral runoff75705Spinal, selective (lumbar arteries)75722Renal, unilateral, selective75724Renal, bilateral, selective75726Visceral, selective or supraselective75731Adrenal, unilateral, selective75733Adrenal, bilateral, selectiveNote: The following codes include “flush aortogram” –75722, 75724, 75726.33ExampleAccess: Right Common Femoral Catheter advanced to the aorta, injection performedfor aortogram. Catheter advanced to the left renalwith injection an imaging, then advanced to the rightrenal with injection and imaging. SMA is selectivelycatheterized with injection and imaging. 36245 (L Renal)36245-59 (R Renal)36245-59 (SMA)75724 (bilateral renals)75726 (SMA)34AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved17
Coding Interventional Radiology ServicesNotes/Comments/QuestionsExampleAccess: Right Common Femoral Catheter advanced to the aorta, injection performedfor aortogram. Catheter advanced to the celiac withinjection an imaging, then advanced to the righthepatic with injection and imaging, then advanced tothe left hepatic with injection and imaging. 3624736248757267577475774(R hepatic)(L hepatic)(Celiac)(R hepatic)(L hepatic)35Venous RS&I Codes 7582075822758257582775831758337584075842Extremity, unilateralExtremity, bilateralCaval, inferior, with serialographyCaval, superior, with serialographyRenal, unilateral, selectiveRenal, bilateral, selectiveAdrenal, unilateral, selectiveAdrenal, bilateral, selective36AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved18
Coding Interventional Radiology ServicesNotes/Comments/QuestionsVenous RS&I Codes 75860 Sinus or jugular, catheter (unilateral)75870 Superior sagittal sinus75872 Epidural75880 Orbital75889 Hepatic, wedged or free, withhemodynamic evaluation75891 Hepatic, wedged or free, withouthemodynamic evaluation37Vena Cavagram 36010 Introduction of catheter, superioror inferior vena cava75825 Caval, inferior, with serialography75827 Caval, superior, with serialographyBoth 75825 & 75827 are reported togetherwhen both studied and interpreted38AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved19
Coding Interventional Radiology ServicesNotes/Comments/QuestionsExamplesAccess: Right brachial vein Catheter advanced to the SVC for injection andimaging. 36010 (SVC) 75827 (SVC)Access: Right brachial vein Injection and imaging of the right arm, catheteradvanced to SVC for injection and imaging. 36010 (SVC) 75820 (Arm) 75827 (SVC)39ExamplesAccess: Right common femoral vein Renal veins selectively catheterized and imaged, leftadrenal catheterized with injection and imaging, lefttesticular vein catheterized for injection and imaging. 3601236012-5936011-5975833758407577440AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved20
Coding Interventional Radiology ServicesNotes/Comments/QuestionsTherapeutic Interventions isThrombectomyDialysis Graft Declotting41Diagnostic Angiography CodingRules w/Therapeutic Interventions Diagnostic angiography (RS&I) codes shouldNOT be used with interventional proceduresfor: Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance forthe intervention, Vessel measurement, and Post-angioplasty/stent angiography as thiswork is captured in the interventionalradiologic supervision and interpretationcode(s).42AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved21
Coding Interventional Radiology ServicesNotes/Comments/QuestionsDiagnostic AngiographyCoding Rules Diagnostic angiography performed at the timeof an interventional procedure is separatelyreportable if: No prior catheter-based angiographicstudy* is available and a full diagnosticstudy is performed, and the decision tointervene is based on the diagnostic study,OR 43Diagnostic AngiographyCoding Rules A prior study is available, but as documentedin the medical record: The patient's condition with respect to theclinical indication has changed since theprior study, OR There is inadequate visualization of theanatomy and/or pathology, OR There is a clinical change during theprocedure that requires new evaluationoutside the target area of intervention44AHIMA 2008 Audio Seminar SeriesCPT Codes Copyright 2007 by AMA. All Rights Reserved22
Coding Interventional Radiology ServicesNotes/Comments/QuestionsDiagnostic AngiographyCoding Rules Diagnostic angiography performed at aseparate setting from an interventionalprocedure is separately reported.Diagnostic angio
Report, Radiology Administrator's Compliance Insider, Health Care Auditing Strategies and she is a frequent contributor to Strategies for Health Care Compliance and to Compliance Monitor Q & A's Ask the Expert. In addition, she is the author of the recently released Radiology Technologist's Coding Compliance Handbook and is a Contributing Editor for The Radiology Manager's Handbook .
