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Basic about Cpt Code for Peripheral Angiogram

Angiography or angiogram is a study of blood vessel like artery or vein through x rays. Angiography is very common while coding Interventional radiology reports in Medical Coding. Vascular procedure will have to perform angiography to find any abnormality in blood vessel. Angiography is performed along with catheterization procedure. Mostly angiography is performed on extremities or peripheral region to find any peripheral vascular disease. The CPT code for peripheral angiography differs with the arteries under study. There are many blood vessels present in our body. Let’s check out how peripheral angiogram CPT code is used for coding different arteries of the body. I would like you to learn first about concept about cpt code for runoff study of abdominal aortogram.

Peripheral Angiogram CPT code for Upper & lower Extremities

Extremities are the most common site to study during Interventional radiology coding. Mostly lower extremities are studying while performing aortogram without runoff. The catheter is inserted through a femoral artery and into the aorta and contrast in injected to study aortogram and also single or both lower extremities. The CPT code for peripheral angiogram will vary for unilateral or bilateral upper and lower extremities. Also, we will code the aortogram for studying aorta. Below are codes used for coding aortogram and extremity angiography.

75625 – Aortogram without runoff, abdominal, radiology supervision and interpretation

75630- Aortogram with runoff, abdominal + bilateral lower extremity, catheter, radiology supervision and interpretation.

75710- Angiography, extremity, unilateral, radiology supervision and interpretation.

75716- Angiography, extremity, Bilateral, radiology supervision and interpretation

When to use CPT code for Peripheral Angiogram with Aortogram

Peripheral Angiography is performed most of times along with Aortogram. Aorta is the main artery through which lower extremity arteries arises. Hence, when a catheter is placed in aorta and contrast in injected the contrast flows into lower extremities. This helps in studying both aortogram and lower extremities together. Hence, we code both aortogram and peripheral angiography together i.e. 75630. Now, we will try to understand through some examples. Learn also about the rules about coding Selective and Non-Selective catheterization.

1. Suppose the Right common femoral artery is accessed with a catheter. The catheter is moved to aorta and injects a contrast without moving from the original position. Now, here the contrast flows in the aorta and enters in both lower extremities. Here if we have the finding supporting for aortogram as well as for both lower extremities, we will code only 75630. This study is called runoff study, because the catheter studies both aortogram and lower extremities from a single position.

2. Again, with same scenario as above, after reaching the aorta, if the catheter injects a contrast at first position and then again moves to another position (junction dividing right and lower extremity) and again injects a contrast. In such case, the study of aorta and bilateral lower extremity is done from different positions. In such case, we will code two codes 75625 (aortogram), 75716 (both extremities), if the finding support for both aortogram and bilateral extremity angiography.

3. Now, the above scenarios can be applied for upper extremities as well. The arteries arising directly from aorta also form Upper extremity. Subclavian artery arises from aorta and divide into Brachial and then into radial and ulnar arteries. Same CPT code for peripheral angiography is used for unilateral (75710) and bilateral (75716) studies of upper extremities.

Related Cpt Code for Peripheral Angiogram

There are a list of angiogram or angiography codes used with different surgery procedure code. These are all supply codes used for coding the radiology part of the procedure (radiological supervision and interpretation).

75625 Aortography, abdominal, by serialography, radiological supervision and interpretation

75630 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation

75635 – Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing

(Do not report 75635 in conjunction with 72191, 73706, 74174 or 74175)

75705 – Angiography, spinal, selective, radiological supervision and interpretation

75726 – Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation

75731 – Angiography, adrenal, unilateral, selective, radiological supervision and interpretation

75733 – Angiography, adrenal, bilateral, selective, radiological supervision and interpretation

75736 – Angiography, pelvic, selective or supraselective, radiological supervision and interpretation

75741 – Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation

75743 – Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation

75746 – Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation

Additional code for CPT code for Peripheral Angiogram

When there is more than one artery is studied after basic exam, we have to use another CPT code for supervision and interpretation 75774. The CPT code 75774 is coded when a more than one artery is studied from same vascular family. This code is an add-on code and can be coded as many times. One has to follow below AMA guideline for coding 75774 CPT code.

Use 75774 in addition to code for specific initial vessel studied

Do not report 75774 as part of diagnostic angiography of the extracranial and intracranial cervicocerebral vessels. It may be appropriate to report 75774 for diagnostic angiography of upper extremities and other vascular beds performed in the same session

There are some related interventional peripheral angioplasty and stent placement cpt codes, which mostly includes the angiography. Below are the list of the angioplasty and stent placement procedures codes.

Before we more ahead we first look at the selective and non-selective and the some lower extremity intervention codes. Their are some coding rules for seletive and non-sective catheterization.

For selective catheter placements, the documentation has to say “selective;” the catheter “cannulated,” “went into,” or was “parked” in the artery. Without that documentation, there is no support to code one of the selective catheter placement codes (Lower extermity selective catheter placement CPT 36245, 36246, 36247, and, sometimes, add-on code 36248).

Insertion of a catheter into the aorta is considered non-selective. The catheter can “enter” the aorta, but it is considered a non-selective vessel. When the documentation shows that the catheter placement was only in the aorta, the non-selective catheter placement CPT code 36200 is coded. This is the main rule to follow to code these vascular catheter placement codes. Once the catheter is placed into a selective artery, the non-selective code is removed and bundled in with the highest selected catheter placement.

These selective catheter placement cpt codes are included with lower extremity intervention procedures. Below are list of those CPT codes. These codes are divided into three territory.

Iliac Vascular Territory

The iliac territory is divided into three vessels: common iliac, internal iliac and external iliac.

The iliac territory is divided into three vessels: common iliac, internal iliac and external iliac.
37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

37221 with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

+37222 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

+37223 ; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for
primary procedure)

Femoral/Popliteal Vascular Territory

The femoral/popliteal territory in one extremity is treated as one vessel. If more than one lesion is treated, report one code based on the most intensive procedure(s) performed.

37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty
37225 ; with atherectomy, includes angioplasty within the same vessel, when performed
37226 ; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
37227 ; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

Tibial/Peroneal Territory
The tibial/peroneal territory is divided into three vessels: anterior tibial, posterior tibial and peroneal arteries.

37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty

37229 ; with atherectomy, includes angioplasty within the same vessel, when performed

37230; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

37231 ; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed

+37232 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

+37233 ; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

+37234 ; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

+37235 ; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

Angioplasty CPT codes other than lower extremity

35471 – Transluminal balloon angioplasty, percutaneous; Renal or visceral artery (deleted in 2017)

35475 – Transluminal balloon angioplasty, percutaneous; Brachiocephalic trunk or branches, each vessel (deleted in 2017)

35476 – Transluminal balloon angioplasty, percutaneous; Venous (deleted in 2017)

Also the related radiologic imaging services codes 75962, 75964, 75966, 75968, 75978 have been deleted in 2017. Checkout the new codes CPT codes for angioplasty below.

Bundled CPT codes for Angioplasty and Thrombectomy

36902 – Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava, fluoroscopic guidance, radiological supervision and interpretation and image documentation and report; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

36903– ; with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment

36904 – Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), and intraprocedural pharmacological thrombolytic injection(s)

36905 ; with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty

36906 ; with transcatheter placement of intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis circui

36907 – Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary procedure)

36908 – Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysis segment (List separately in addition to code for primary procedure)

36909– Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in addition to code for primary procedure)

37246 – Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery

37247 ; each additional artery (List separately in addition to code for primary procedure)

37248 – Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein

37249 ; each additional vein (List separately in addition to code for primary procedure)

Hope, now you would have got a clear picture about coding peripheral angiogram cpt code. Do share this article if you liked it.