Billing Diagnostic Angiograms with Lower Extremity Interventions

Question:

Are diagnostic angiogram billable with a lower extremity intervention, such as an atherectomy or stent? I’ve been told they are bundled.

Answer:

That is a common misunderstanding. Diagnostic angiograms are separately billable during a lower extremity intervention such as an atherectomy or stent intervention if no prior adequate diagnostic angiogram is available to the physician. For example,

• no previous angiogram is available,
• the prior angiogram is not adequate to diagnose the disease or
• the patient’s condition changed either since the last angiogram or during the procedure.

Document if any of these situations exists and code the diagnostic angiogram(s) with a 59 modifier (or XU) to indicate that there was no adequate diagnostic angiogram available. And remember Medicare considers a CTA to be equivalent to a catheter-based angiogram. So if a Medicare patient had a CTA that met the physician’s diagnostic purposes, a diagnostic angiogram would not be billable in addition to an intervention.