A coronary angiogram or angiography is a common procedure that uses X-ray imaging to see your heart’s blood vessels such as an artery or vein. This test is performed to see if there is any restriction or abnormality in blood flow going to the heart. Typically, most angiographic procedures are performed in extremities or peripheral regions to diagnose any peripheral vascular disease. These procedures require adequate documentation, which is effectively provided by medical coding companies that serve medical professionals.
How Is Coronary Angiography Performed?
Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterizations which can both diagnose and treat heart and blood vessel conditions. Cardiac catheterization is most commonly performed to examine the coronary arteries because heart attack, angina or heart failure most often originates from disease in these arteries. In addition, this procedure may reveal the presence of other conditions, including enlargement of the left arteries, ventricular aneurysms (abnormal dilation of a blood vessel), narrowing of the aortic valve, and septal defects that allow an abnormal flow of blood from one side of the heart to the other.
Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not significantly uncomfortable. To begin with the procedure, a physician inserts a small catheter (a thin hollow tube with a diameter of 2-3 mm) through the skin into an artery in either the groin or the arm. Guided with the assistance of a fluoroscope (a special X-ray viewing instrument), the catheter is then advanced to the opening of the coronary arteries. A small amount of radiographic contrast dye (visible in X-ray machine) is injected into each coronary artery. The images that are produced are called the angiogram and this shows where the arteries are blocked. Once the procedure (that approximately takes 20-30 minutes) is over, the catheter is removed and the artery in the leg or arm is sutured, “sealed,” or treated with manual compression to prevent bleeding.
Usually, the procedure of cardiac cath is safe. However, a very small number of people experience minor problems like developing bruises where the catheter has been inserted. The contrast dye that make the arteries show up on X-rays causes some people to feel sick to their stomachs, get itchy or develop hives.
Angiography Procedure – CPT Codes
The Current Procedural Terminology (CPT) codes for peripheral angiography differ with the arteries under study.
CPT Codes for Peripheral Angiography for Upper and Lower Extremities
Extremities are the most common sites to study during interventional radiology medical coding. Generally, lower extremities are studied while performing aortogram without runoff. The CPT codes for peripheral angiogram will vary based on unilateral or bilateral upper and lower extremities. In addition, coding will be done for aortogram for studying the aorta. Let’s look at some 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
Peripheral angiography is performed mostly with aortogram. Since the aorta is the main artery through which lower extremity arteries arise, when a catheter is placed in the aorta and contrast dye is injected, the dye flows into lower extremities. This helps in studying aortogram and lower extremities together. Hence, coding for both aortogram and peripheral angiography is done together – using code 75630.
CPT Codes for Angiography
- 75635 – Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including non-contrast images, if performed, and image post-processing
- 75658 – Angiography, brachial, retrograde, radiological supervision and interpretation
- 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
When more than one artery is studied from the same vascular family after a basic examination, another CPT code – 75774 is used for supervision and interpretation. This is an add-on code and can be coded many times.
Other Related Codes
There are certain related angioplasty and stent placement CPT codes, which usually includes angiography.
CPT Codes for Angioplasty
- 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 – 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 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 – 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); with transluminal balloon angioplasty, peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty
- 36906 – Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty
- 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
- 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
- 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 – 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; 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 – 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; each additional vein (List separately in addition to code for primary procedure)
CPT Codes for Stent Placement
- 37221 – Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed
- 37223 – Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within same vessel, when performed (List separately in addition to code for primary procedure)
- 37226 – Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- 37230 – Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
- 37234 – Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
- 37236 – Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
- 37237 – Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure)
- 37238 – Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
- 37239 – Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure)
Healthcare providers and medical coders are required to have the knowledge and expertise required to code separate procedures accurately and avoid claim denials and delayed payment. Outsourcing the coding tasks to a reliable medical billing and coding company that provides the services of AAPC-certified coders can help tackle all kinds of processes related to coding separate procedures.
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