Ask Dr. Z

Thank you for the time you undoubtedly spent reading through and analyzing this report. I see we were pretty close on the coding, except for the use of the additional 75710,26 and the use of 75774,26, RT. We did have 36246,RT coded, I just neglected to include it when I submitted the initial question. The reason I used the additional 75710,26 was because the initial one was retrograde and the one performed near the end of the session was antegrade, although from the same location. The reason I used 75774,26,RT was, because, after the initial bilateral lower extremity angiograms from the aortoiliac bifurcation (75716,26), another angiogram was performed after the catheter was advanced to the external iliac artery, and prior to what I thought were the supervision and interpretation related studies, for further, more detailed, diagnostic study of the leg. Could you, please, explain to me why you chose not to code those? I also noticed that you considered all of the additional views and projections a part of the other radiological procedure codes, which is the direction I was leaning in, and chose not to include ultrasonographic codes, which is what I was really stuck on. Could you walk me through your decision making process, as it pertains to those codes? My thinking is that the duplex wouldn't be coded, because the doctor just mentioned reference to it, as opposed to actually performing it. Even if she did perform it, it wasn't clear in the op report. On the other hand, although it's not flagged by NCCI edits, would you consider a duplex inclusive to the other procedures, even if it was clearly stated that it was performed intraoperatively? If you would code it separately, would you code it as a duplex (93925/93926) or as intraoperative ultrasound (76998/76937)? I imagine intravascular ultrasound (37250/37251) would only be used if ultrasonography was performed through an intravascular catheter, but I'm not sure. As you can see, I appreciate the guidance you've already provided, but I still have a lot of questions about these kinds of cases. I have a hard time differentiating between the different codes and when it's appropriate to use (or not use) each code. I want to fully understand the reasoning and logic behind your decisions so I can apply them to future cases. Thanks, again.