Basics of Spinal Angiography CPT code 75705

Spinal angiography involves catheter placement into paired spinal arteries (intercostal above and lumbar below the diaphragm) with injection of contrast and imaging of the blood flow to the spine or spinal cord. This may also include bilateral catheter selection and injection of contrast with imaging of the supreme intercostal, subclavian, thyrocervical, vertebral, internal iliac, median sacral, and internal iliac arteries. CPT code 75705 is used for reporting spinal angiography diagnostic exam.

In this procedure, a local anesthetic is applied over the artery of access, usually the common femoral artery. The artery is percutaneously punctured with a needle and a guidewire is fed through the artery into the aorta. Under fluoroscopic guidance, a catheter is threaded over the guidewire to the aorta and advanced directly into a spinal artery suitable for viewing the study area. The guidewire is removed. Contrast medium is injected in the lowest level first and just above that in sequence and films are taken until the study has covered the area of interest. CPT code 75705 reports the radiological supervision and interpretation only. Separate CPT codes are use for the catheterization.

A procedure is performed to study selective spinal arteries using radiopaque contrast medium and fluoroscopy. Selective spinal angiography images the blood flow to the spine and spinal cord and may be used to diagnose arteriovenous malformations and primary metastatic tumors of the vertebral bodies.  A large bore needle is inserted into a blood vessel in the groin, a guidewire is introduced through the needle, and a catheter is advanced over the guidewire into the aorta using X-ray guidance.

The catheter is then placed into the appropriate selective paired spinal arteries: intercostal, subclavian, thyrocervical, costocervical above the diaphragm and vertebral, internal iliac, lumbar, and median sacral below the diaphragm. Contrast medium is injected and X-ray images are obtained. The catheter is removed at the end of the procedure. CPT code 75705 reports the radiologist’s supervision of the selective spinal angiography procedure, review of records and interpretation of the findings, and a written report.

CPT codes for Catheterization

Before we move ahead and look for the CPT codes description, you will have to first understand the meaning of “Selective” in coding these catheterization procedures.

Each procedure code will have “Selective” word in their code description. The word “Selective” here is the catheter should cross or present or placed on the selected artery to report that order of the artery.

Similarly for coding spinal angiography, the catheter should be placed or cross those spinal artery, in order to report the spinal angiograhy CPT code 75705.

36215 Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family

36216  Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family

36217  Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family

36218  Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate)

36245 Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family

36246  Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family

75705  Spinal angiography, per vessel (selective), if supplying spinal structure

75726  Spinal angiography, per vessel (selective), if supplying bronchial structure

75736  Median sacral angiography (selective), if supplying pelvic structure           

75705  Internal iliac angiography (selective), if supplying spinal structure (for S3-S5)

75705  Median sacral angiography (selective), if supplying spinal structure (for S1-S2)

75710  Subclavian angiography  

75705  Supreme intercostal angiography (after selective catheter placement into the vessel), if supplying spinal structure

75726  Supreme intercostal angiography (after selective catheter placement into the vessel), if supplying bronchial structure

+75774  Costovertebral trunk angiography (following subclavian) (additional vessel, selective, after basic exam)

+75774  Thyrocervical trunk angiography (following subclavian) (additional vessel, selective, after basic exam)   

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Do and Don’t Spinal Angiography CPT code 75705

CPT code 75705 (spinal angiography) requires a selective catheter placement into the vessel to use this code.

CPT Code 75705 is a unilateral code. It can be used twice if the procedure is done bilaterally (75705 and 75705-59).

Spinal angiography (75705) has an MUE of 20 and hence this code may be used upto 20 times appropriately when a comprehensive spinal angiogram is performed.

When the intercostal artery is injected for spinal angiogram, use CPT code 75705 for any spinal abnormality and when brochial bleed or other bronchial abnormality is studied use CPT code 75726 while injecting the intercostal artery. Documentation support is important in these kind of scenarios.

The middle or median sacral artery is considered a spinal artery (75705) if injected to evaluate the sacrum (S1 and S2 bilaterally) for neurologic abnormalities. If injected to image a pelvic mass (e.g., bladder tumor), use code 75736.

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HCPCS codes related to CPT code 75705

G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
Q0035 Cardiokymography

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