Ask Dr. Z

Is a CT angiogram now considered an equivalent study to a catheter based angiogram?

Why am I asking this question?  Well, each year I print out the NCCI written instructions, place it in a binder in the MD reading room.  I highlight and flag the different practice areas for my physicians here. This is the version that releases in Oct."XX.3."  I was looking last week for this year's release, it is not being released until December this year.  I happened to glance through it and it stated that diagnostic angiography cannot be billed if the patient has had a CT angiogram or prior diagnostic catheter based angiogram.  (Unless of course those were suboptimal images or change in patient status/symptoms).  Has this changed then in the past year or so?  I attempted to find a clarification in your 2011 Diagnostic & Interventional Cardiology Coding book, but was unsuccessful. (I trust your guidance over others!)  Recently, I am seeing more patients coming in having had a CT angio now that suggested stenosis or aneurysm.


NCCI Version 16.3 Chapter 9 CPT 70000-79999- D. 4.--
4. Diagnostic angiography (arteriogram/venogram) performed on the same date of service by the same provider as a percutaneous intravascular interventional procedure should be reported with modifier 59. If a diagnostic angiogram (fluoroscopic or computed tomographic) was performed prior to the date of the percutaneous intravascular interventional procedure, a second diagnostic angiogram cannot be reported on the date of the percutaneous intravascular interventional procedure unless it is medically reasonable and necessary to repeat the study to further define the anatomy and pathology. Report the repeat angiogram with modifier 59. If it is medically reasonable and necessary to repeat only a portion of the diagnostic angiogram, append modifier 52 to the angiogram CPT code. If the prior diagnostic angiogram (fluoroscopic or computed tomographic) was complete, the provider should not report a second angiogram for the dye injections necessary to perform the percutaneous intravascular interventional procedure.

It appears that I am not able to charge for a diagnostic catheter based angiogram when  a  patient comes in for a diagnostic study and possible intervention if they have already had a CT angiogram that was a complete study and they have not had any changes in their symptoms.  Do you concur?

Thank you so much for your time,guidance and patience.  Every day is a new day of learning!!!