Q: How do I code for geniculate artery embolization (GAE) for osteoarthritis or for hemarthrosis?
A: As with other embolization procedures, GAE for osteoarthritis and for hemarthrosis is reported using the general embolization codes and based on individual components of the procedure. Selective arterial catheterizations (36245–36248) should be reported according to catheter selectivity. The appropriate CPT code to report for embolization component is 37242 (Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor). Associated diagnostic angiography radiological supervision and interpretation (RS&I) (75710 and/or 75716) may be reported when criteria for reporting diagnostic angiography is met and documented appropriately.
Q: What defines “diagnostic angiography” and how is this different from routine angiography?
A: Routine angiography includes arteriograms for intervention guidance, confirmation of anatomy prior to treatment, roadmapping, vessel measurement and arteriograms to document treatment completion. These are not separately billable from component coding. Diagnostic angiography (RS&I codes), however, is specific for diagnosing pathology and/or planning therapy for pathology and leads to medical decision making. Diagnostic angiography adds new information to prior studies. The report must include a full description of anatomy and findings. Diagnostic angiography can be reported with an intervention if certain criteria are met, including no prior available catheter-based angiography study, a full diagnostic study is performed and the decision to intervene is based on that study (including which vessels to treat or how to treat).
If a prior study is available, diagnostic angiography can still be reported if the prior study demonstrates inadequate visualization of the pathology or anatomy involved or the patient’s clinical status has changed since the prior study, as long as a description of reasoning is documented. Additionally, if a change in clinical status during the procedure requires angiographic evaluation outside the area of intervention, diagnostic angiography may be reported if documented appropriately. The use of diagnostic angiography in the setting of an intervention should be reported with modifier 59 (or appropriate modifier as dictated by individual payer policy) to denote that the aforementioned criteria have been met.
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2022/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2022 CPT® for full and complete guidelines.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
