Abdominal Aortography, the basics
An abdominal aortogram describes imaging of the abdominal aorta, which is the segment of the aorta from the level of the renal arteries to the aortic bifurcation (where the aorta ‘splits’ into the left and right common iliac arteries). These are the ‘landmarks’ that need to be described in order to code for an abdominal aortogram.
With or without runoff?
When the report also describes lower extremity runoff, this refers to imaging of the iliofemoral arteries (the lower extremities to at least the femoral arteries) in addition to the abdominal aorta. Keep in mind that the ‘runoff’ terminology may be used in other situations, so code by the procedure description and not a title.
How is this done, and what does it mean for coding?
There are multiple ways this procedure can be performed, and how it is performed impacts the way the procedure will be coded. Generally, the catheter is placed at or above the level of the renal arteries and contrast is injected. Because the aorta carries blood away from the heart, the flow will carry the contrast down to the lower part of the abdominal aorta and into the iliofemoral arteries.
This imaging can be done from the initial high catheter placement in the aorta, without repositioning the catheter to the lower part of the abdominal aorta. CPT® code 75630 describes abdominal aortography with bilateral iliofemoral runoff from this single high catheter position.
More commonly, the catheter will be repositioned to the lower part of the abdominal aorta for the imaging of the iliofemoral arteries. When the catheter is moved to a lower position for imaging of the lower extremities, two codes would be assigned: 75625 and 75716 (bilateral lower extremities – 75710 for unilateral).
Even though the radiologist is viewing and commenting on the same structures for both coding options, the difference when choosing the correct code is how the procedure was performed. The movement, or lack of movement, of the catheter is the key.
When in doubt, ask yourself:
did the catheter move?
If yes, 75625 and 75716. If no, 75630. Assuming, of course, all documentation requirements for a complete abdominal aortogram with lower extremity runoff are met.
In either scenario, only one catheterization code (36200) would be assigned since the catheter is still in the aorta.