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"Radiology coders must have a clear understanding of the various steps involved with angiography to diagnose a pulmonary embolism (PE) and subsequent intervention to restore blood flow. This will ensure correct coding and proper reimbursement for this multistep procedure. In many cases, patients are elderly, previously have been hospitalized for other conditions or are experiencing acute symptoms including complete cardiopulmonary arrest. Interventional radiologists often may be called upon to perform the pulmonary angiography on an urgent basis. These circumstances may require them to customize the examination significantly, allowing them to respond to unusual or emerging symptoms. During the course of the procedure, the interventionalist also may provide additional ancillary services such as thrombolysis and/or IVC (inferior vena cava) filter placement. In patients where PE is suspected, pulmonary angiography is performed to confirm or exclude the possibility of an embolism. Diagnosis codes that support pulmonary angiography include shortness of breath (786.05), painful respiration (786.52), primary pulmonary hypertension (416.0), chronic cardiopulmonary disease (416.9) and cardiorespiratory arrest (427.5). If a PE has been confirmed, the appropriate code is 415.19 (pulmonary embolism and infarction, other). Coders should avoid using the ICD-9 code for the patients underlying medical or surgical condition unless it is also the reason for the pulmonary angiogram. For example, should a patient with recent orthopedic surgery or trauma need an angiogram to rule out PE, do not use the diagnosis code of the orthopedic procedure or of trauma to justify the angiogram. According to Lisa Grimes, RT (R), radiology special procedures technologist and reimbursement specialist for the University of Texas/Houston Health Science Center, the procedure typically involves multiple steps, each of which may be billed. In most instances, these steps include catheter placement, angiography, transcatheter therapy, placement of filters to entrap clots and the appropriate supervision and interpretation codes. Pulmonary Embolism Case Study Procedure: A 68-year-old male, five days postoperative for total hip replacement, complains of chest pain and severe shortness of breath. Within minutes, the patient loses consciousness and suffers cardiopulmonary arrest. The patient is resuscitated, placed on a ventilator and transferred to the catheterization lab. The interventional radiologist then performs pulmonary angiography. The patients right groin is prepped and the patient is draped. A 7-French sheath is placed into the right femoral vein, and a pigtail catheter is advanced to the confluence of the iliac veins. A hand injection with fluoroscopic monitoring of the IVC is performed to rule out IVC clot. The catheter is advanced into the right atrium. Using a guide-wire, the catheter is placed through the atrium, right ventricle and pulmonary outflow tract into the right pulmonary artery. Right pulmonary artery pressures are obtained. Right pulmonary angiography is performed using 40 cc of contrast……. For more read:-
http://www.supercoder.com/articles/articles-alerts/rca/code-FOR-EACH-STEP-TO-OPTIMIZE-REIMBURSEMENT-FOR-PULMONARY-ANGIOGRAPHY/
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radiology codes, pulmonary angiography, medical coding, medical billing, icd-9 codes, cpt codes, hcpcs codes,
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