Pelvic angiography – it’s a term we see in reports and there’s a CPT® code specifically describing it, so why is this code so frequently mis-used? The answer to that involves understand what the definition of true pelvic angiography entails and the key terms to look for in documentation to support it.
Selective (True) Pelvic Angiography
True pelvic angiography is the evaluation of the arteries that supply the interior / internal anatomy of the pelvis.
Documentation key phrases: the catheter is selectively placed in the internal iliac (i.e., hypogastric) artery or a branch of the internal iliac artery (i.e., anterior division, posterior division, etc.).
75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation
The most common mistake associated with the use of this code (75736) is assigning it when a provider states that a pelvic angiogram was performed but the documentation doesn’t state that the catheter was placed into the internal iliac artery. This is the key to proper use of code 75736 – to be a true pelvic angiogram, the catheter must be selectively placed into the internal iliac artery or a branch of the internal iliac artery. For imaging of the common or external iliac arteries, or for non-selective “pelvic” angiography from the bifurcation, this code should not be assigned.
Note that this code does not specify unilateral or bilateral, so it is considered unilateral in nature. If bilateral internal iliac arteries are selected and imaged, 75736 would be assigned twice.
Non-Selective Pelvic Angiography
What if true pelvic angiography is not performed? We know we can’t assign 75736 in that case, but what would be the proper code? The answer is extremity angiography codes 75710 (unilateral) or 75716 (bilateral). When we think of the extremities we tend to think of the arms and legs, so it may not seem intuitive to assign 75710 or 75716 when the report states that a pelvic angiogram was performed. However, when we think about where the lower extremities start it’s in the pelvic area, so it is an anatomic area associated with the lower extremities.
Documentation key phrases: the catheter is non-selectively placed in the distal abdominal aorta with AP (anteroposterior) and/or bilateral oblique imaging of the pelvis. Another way this may be said is: the catheter is placed in the common iliac(s) and images are taken over the pelvic area. Note that in these examples there is no mention of the catheter being placed in the internal iliac(s).
As always, the critical piece of information to establish when determining code selection is where the catheter was placed. This is the primary difference in determining whether the code for selective pelvic angiography should be used or not. Other keys for coding selective and non-selective pelvic angiography are outlined below.
Selective Pelvic Angiography (75736)
- Determine where the catheter is placed (i.e., internal iliac/hypogastric) as well as whether imaging was performed unilaterally or bilaterally
- Selective pelvic imaging may be separately coded when performing uterine artery embolization for post-partum hemorrhage or MVAs (motor vehicle accidents) – see embolization code 37244
- Before assigning code 75736 for imaging performed at the same time as a scheduled uterine artery embolization for fibroids, be certain this imaging is truly diagnostic and not merely confirmatory
Non-Selective Pelvic Angiography (75710/75716)
- Determine where the catheter is placed (i.e., mid-aorta, distal aorta, common iliac artery, etc.)
- Determine whether imaging was performed unilaterally (75710) or bilaterally (75716)
- Evaluation of the common, internal or external iliac(s) from either a non-selective aortic or selective common or external iliac artery injection is still defined by 75710 or 75716 – not 75736
For a detailed walk through of coding for pelvic angiography and other lower extremity imaging and interventions, check out this on-demand webinar.