Radiology

Abdominal Aortography with Lower Extremity Runoff: Did the Catheter Move?

The abdominal aortogram is one of the most commonly performed peripheral services – yet coding for abdominal aortograms, especially with lower extremity runoff, is something that is often met with questions about just how to ensure the correct code (or codes) is being selected for the procedure performed. When in doubt, there’s one question that can often help provide clarity to code selection: did the catheter move?

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 must be described in the documentation in order to code for an abdominal aortogram.

Often, after an abdominal aortogram is performed, additional imaging is done of the lower extremities. This may be referred to in documentation as an ‘abdominal aortogram with runoff’, ‘AIF’, or ‘AIFF’. 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.

Code Choices

For abdominal aortograms performed with or without runoff, the following codes are used:

75625    Aortography, abdominal, by serialography, radiological supervision and interpretation

75630    Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation

75710    Angiography, extremity, unilateral, radiological supervision and interpretation

75716    Angiography, extremity, bilateral, radiological supervision and interpretation

There are multiple ways abdominal aortography and lower extremity angiography are performed. Pay close attention to the documentation to determine the appropriate code(s).

How is the Procedure Performed? How is Coding Impacted?

As mentioned above, there are multiple ways abdominal aortography can be performed, and how the procedure is performed impacts the way it 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.

 

Code 75625 is reported for an abdominal aortogram from an injection of contrast from a catheter in the upper abdominal aorta, usually at or above the renal arteries, with documentation of imaging from the renal arteries to the aortic bifurcation. This code is assigned when a complete abdominal aortogram is performed without documentation of lower extremity imaging.

If, after the abdominal aortogram is performed, additional imaging is done of the lower extremity (iliofemoral) arteries without repositioning the catheter to the lower part of the abdominal aorta, code 75630 would be assigned. Code 75630 describes abdominal aortography with bilateral lower extremity (iliofemoral) runoff from the initial, single high catheter position in the upper abdominal aorta.

 

More commonly, the catheter will be repositioned to the lower part of the abdominal aorta for 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). 

Code(s) What Needs to be Imaged Where is the Catheter Placed Documentation Keys
75625 The complete abdominal aorta (from the level of the renal arteries to the aortic bifurcation) Upper abdominal aorta, at or above the level of the renal arteries • The complete abdominal aorta without imaging of the lower extremities
75630 Complete abdominal aorta (from the level of the renal arteries to the aortic bifurcation) and bilateral lower extremities to at least the level of the femoral arteries Upper abdominal aorta, at or above the level of the renal arteries. All imaging is done from this single high catheter placement • The complete abdominal aorta • Imaging of both lower extremities to at least the level of the femoral arteries • No movement of the catheter for the lower extremity imaging • If no mention is made of the upper abdominal aorta (i.e., are the renal arteries defined?) this is not 75630 but either 75716 or 75710
75625 + 75716 Complete abdominal aorta (from the level of the renal arteries to the aortic bifurcation) and bilateral lower extremities to at least the level of the femoral arteries Upper abdominal aorta, at or above the level of the renal arteries followed by moving the catheter to the lower abdominal aorta (bifurcation) for imaging of the lower extremities • The complete abdominal aorta • Imaging of both lower extremities to at least the level of the femoral arteries • Movement of the catheter for lower extremity imaging • If interpretation of the abdominal aorta and only one extremity, report 75625 and 75710 instead

Free anatomical Aorta Coding Chart!

Includes full diagram with code asssigment