Billing Separately for Diagnostic Angiograms

Question:

Our surgeon performed an aortogram with run-off to bilateral lower extremities. He then performed interventions in the left SFA and the left peroneal arteries. My question is regarding documentation of the diagnostic imaging Can he also bill for a diagnostic angiogram? What about catheterization to get there?

Answer:

Diagnostic imaging during lower extremity arterial revascularization procedures such as stent and atherectomy, may be separately billed at the same session as the intervention when:

• no previous diagnostic study is available,
• the prior study(ies) do not adequately to diagnose the disease or
• the patient’s condition changed either since the last study or during the procedure

Although CPT considers only catheter- based angiograms as a prior study, Medicare considers a CTA to be a prior diagnostic study. Catheterization is always bundled with lower extremity arterial interventions, including angioplasty, stenting or atherectomy.