Coding Q & A


Ultrasound Guidance/Coronary CTA/Uterine Artery Embolization/Inferior Vena Cavagram

Q: Which of the following statements is/are false regarding ultrasound guidance?

  1. Dictation must state permanent images are stored
    CORRECT. This is a false statement. The ultrasound guidelines state that a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized, is required. It does not require that the report state "permanent images are stored."
  2. Requires permanently recorded images of the site to be localized
    INCORRECT. This is a true statement.
  3. Documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized.
    INCORRECT. This is a true statement.
  4. None of the above
    INCORRECT.

Q: CT angiography is performed to rule out pulmonary embolism, aortic dissection and coronary ischemia. The appropriate code(s) to report is/are:

  1. 76497
    INCORRECT. At this time, the unlisted computed tomography code describes a CTA of the coronary vasculature. It does not describe a CTA of the aorta and pulmonary arteries.
  2. 71275
    INCORRECT. The CTA of the chest code 71275 describes the evaluation of the aorta and pulmonary vasculature. It does not describe a CTA of the coronary arteries.
  3. 76497 + 71275
    CORRECT. The unlisted computed tomography code 76497 is used, at this time, to report a CTA of the coronary vasculature and the CTA of the chest code 71275 describes a CTA of the aorta and pulmonary arteries.
  4. 76497 + 71250
    INCORRECT. The unlisted computed tomography code 76497 correctly describes a CTA of the coronary vasculature at this time, but code 71250 describes a CT of the thorax--not a CTA of the chest.

Q: A complete diagnostic pelvic arteriogram of both internal iliac arteries is performed on the same day and prior to uterine artery embolization for the treatment of uterine fibroids. The appropriate imaging code(s) to report in addition to the procedural code(s) is/are:

  1. 75736-LT, 75736-RT
    INCORRECT. This describes the imaging associated with the catheter placement only. Additional imaging was performed and needs to be reported separately.
  2. 75736, 75736-59
    INCORRECT. This does not describe all of the associated imaging performed.
  3. 75736-LT, 75736-RT, 75736-59, 75894, 75898-LT, 75898-RT
    CORRECT. The imaging associated with the catheter placement is reported twice, once for each side. The diagnostic angiogram is coded 75736 with a modifier to distinguish it as a separate and distinct study from the imaging associated with the placement of the catheters. The embolization radiologic supervision and interpretation is reported only once by code 75894. The follow up angiogram is reported twice by 75898 with modifiers since a study was performed on both the right and left sides.
  4. 75736-LT, 75736-RT, 75736-59
    INCORRECT.

Q: A full and complete inferior vena cavagram and IVC filter placement is appropriately coded:

  1. 36010, 37620, 75825, 75940
    CORRECT. 36010 describes access into the inferior vena cava, 75825 describes the diagnostic IVC study, 37620 describes the filter placement, and 75940 is the associated radiologic supervision and interpretation code for the filter placement.
  2. 36010, 75825
    INCORRECT. Codes 36010 and 75825 describe the access into the inferior vena cava and the diagnostic IVC study. The filter placement and radiologic supervision and interpretation codes should be coded as well.
  3. 37620, 75940
    INCORRECT. Codes 37620 and 75940 describe the IVC filter placement and corresponding radiologic supervision and interpretation. The access into the inferior vena cava and the diagnostic inferior vena cavagram should be coded as well.
  4. 36010, 37620, 75940
    INCORRECT. The diagnostic inferior vena cavagram performed prior to the IVC filter placement should be reported as well.

Q: Does the ultrasound guidance clarification provided in CPT require that the radiologist state within the report that "permanent images are stored"?

A: No, the ultrasound guidance clarification provided in CPT 2005 does not require that the radiologist state within the report that "permanent images are stored." The guidelines state "Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized." According to these guidelines, the radiologist is required to dictate a statement about the localization process, eg, ultrasound guidance was used for needle placement, NOT that permanent images are stored. These "permanent images" should be retrievable in the event of a practice audit.

Note that the CPT® descriptor for ultrasound guidance used during vascular access (code 76937) specifically lists the requirements for using this code. The descriptor notes that this code requires ultrasound evaluation of the potential access sites, documentation of selected vessel patency, and concurrent real-time ultrasound visualization of vascular needle entry, with permanent recording and reporting.

All radiologists should follow CPT® guidelines, and coders should make sure the radiologists are informed of the guidelines. While some radiologists may choose to dictate that permanent images were obtained, it is not required by CPT® coding guidelines. As noted previously in this newsletter, original source documentation (AMA, CMS, CDC, specialty society publications, etc.) should be used when determining what is or is not appropriate coding.