Radiology Question for the Week of February 29, 2016

Question:

How does one properly code for an unsuccessful (i.e., failed) procedure to recanalize (cross a chronic total occlusion [CTO]) an obstructed peripheral artery (i.e., lower leg)? Only the CTO equipment was opened and used. No angioplasty catheter or stent was opened or used.

Answer:

This is one of those questions that if you ask five people, you’ll get at least four different answers. Conflicting answers to similar questions have appeared in Coding Clinic for HCPCS. In reality, there isn’t one answer; each case would need to be determined individually based on what was scheduled and performed. 

For outpatient hospital billing to Medicare, if the patient is scheduled for revascularization and an attempt was made, you could code the planned procedure with modifier -74. If the patient was scheduled for angiography, with intervention as necessary, and after the angiogram the intervention could not be performed (the physician could not get a wire through) then code only the angiogram. If the physician used the angioplasty catheter but could not get the wire through, then a code would be assigned for the angioplasty with modifier -74, although the safest would be to code the angiogram only. 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.