Comprehensive Coding Guide: Abdominal Aortography & Renal Angiography CPT & ICD-10 Codes
Welcome to your essential guide for accurately coding diagnostic abdominal aortography and renal angiography procedures. As an expert resource for healthcare professionals, we understand the critical importance of precise medical coding for reimbursement, compliance, and patient care. This post has been thoroughly updated to reflect current industry standards, including the mandatory transition from ICD-9 to ICD-10-CM codes, and incorporates the latest **CMS coverage guidelines** to optimize your billing processes.
Diagnostic abdominal aortography and renal angiography are specialized imaging procedures used to visualize the aorta and renal arteries, respectively. They are crucial for diagnosing various vascular conditions such as **renal artery stenosis**, **aortic aneurysms**, atherosclerosis, and peripheral vascular disease. Accurate coding ensures proper billing and avoids claim denials, making this comprehensive resource indispensable for coders, billers, and healthcare providers.
CPT/HCPCS Codes for Diagnostic Abdominal Aortography and Renal Angiography
Accurate application of CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) codes is fundamental for billing these complex interventional radiology procedures. Each code carefully describes the specific service performed, including catheter placement, imaging supervision, and interpretation. Providers must ensure documentation fully supports the selected codes, reflecting the extent and complexity of the procedure.
Understanding CPT/HCPCS Codes for Abdominal Aortogram CPT Codes and Renal Artery Angiography
| Code | Description | Detailed Context |
|---|---|---|
| 36200 | Placement of catheter in aorta | Initial placement of a catheter in the aorta for diagnostic purposes, often as a prelude to more selective catheterization. |
| 36245 | Selective catheter placement, abdominal or lower extremity artery, initial first order or higher artery, unilateral | Used for the selective catheterization of the initial artery within the abdomen or lower extremity (e.g., common iliac, external iliac, superficial femoral artery) on one side. |
| 36246 | Selective catheter placement, abdominal or lower extremity artery, second order or higher artery, unilateral | Applies to the selective catheterization of a second branch artery beyond the initial vessel (e.g., profunda femoris, popliteal) on one side. |
| 36247 | Selective catheter placement, abdominal or lower extremity artery, third order or higher artery, unilateral | Used for selective catheterization of a third or higher order branch artery within the abdomen or lower extremity on one side. |
| 36248 | Selective catheter placement, abdominal or lower extremity artery, additional vessel, unilateral or bilateral | Add-on code for each additional selective catheterization of an abdominal or lower extremity artery beyond the primary (initial) selective vessel(s) and their respective orders. |
| 36251 | Selective catheter placement, renal artery, unilateral, first order or higher | Used for the initial selective catheterization of a renal artery on one side, typically for renal angiography. This is a common **CPT codes for renal artery stenosis angiography** procedure. |
| 36252 | Selective catheter placement, renal artery, bilateral, first order or higher | Applies when both renal arteries are selectively catheterized in the same session. |
| 36253 | Selective catheter placement, renal artery, unilateral, second order or higher | Used for selective catheterization of a second or higher order branch of a renal artery on one side. |
| 36254 | Selective catheter placement, renal artery, bilateral, second order or higher | Used when second or higher order branches of both renal arteries are selectively catheterized. |
| 75625 | Aortography, abdominal, radiological supervision and interpretation | Radiological supervision and interpretation for imaging of the abdominal aorta with contrast. This code is often paired with a catheterization code (e.g., 36200). |
| 75630 | Aortography, abdominal and lower extremity, radiological supervision and interpretation | Radiological supervision and interpretation for imaging of the abdominal aorta and bilateral lower extremity arteries with contrast. |
| 75726 | Angiography, renal, unilateral or bilateral, radiological supervision and interpretation | Radiological supervision and interpretation for imaging of the renal arteries with contrast, often linked to selective renal artery catheterization codes (e.g., 36251, 36252). |
| G0278 | Iliac artery angiography, nonselective, radiological supervision and interpretation | HCPCS code for nonselective angiography of the iliac arteries, typically performed in conjunction with cardiac catheterization. |
ICD-10-CM Codes Supporting Medical Necessity
The transition from ICD-9 to ICD-10-CM codes, effective October 1, 2015, brought significant changes to diagnostic coding, requiring greater specificity. The following **renal angiography ICD-10** and abdominal aortography ICD-10 codes provide robust support for medical necessity, crucial for avoiding billing errors and denials.
ICD-10 Codes for Renal Artery Disease and Renovascular Conditions
| ICD-10 Code(s) | Description |
|---|---|
| I10 | Essential (primary) hypertension (Malignant essential hypertension) |
| I12.0, I12.9 | Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease (I12.0) or unspecified (I12.9) |
| I13.0, I13.10, I13.11, I13.2 | Hypertensive heart and chronic kidney disease with/without heart failure and various CKD stages |
| I15.0 | Renovascular hypertension |
| I15.8 | Other secondary hypertension (for unspecified renovascular hypertension) |
| I70.1 | Atherosclerosis of renal artery (includes hyperplasia of renal artery) |
| I72.2 | Aneurysm of renal artery; Dissection of renal artery |
| I75.81 | Atheroembolism of kidney |
| N28.89 | Other specified disorders of kidney and ureter (includes vascular disorders of kidney) |
| N28.9 | Disorder of kidney and ureter, unspecified |
| Q27.39 | Other congenital malformations of renal vessels |
| R94.31 | Abnormal results of kidney function studies |
ICD-10 Codes for Aortic Aneurysms, Atherosclerosis, and Peripheral Vascular Disease
| ICD-10 Code(s) | Description |
|---|---|
| I70.0 | Atherosclerosis of aorta |
| I70.20-I70.39 (with 7th characters) | Atherosclerosis of native arteries of the extremities; Atherosclerosis of bypass graft of the extremities (e.g., for lower extremity disease associated with aortography) |
| I71.0xx – I71.9 (with 7th characters) | Aortic aneurysm and dissection of various sites (thoracic, abdominal, thoracoabdominal, unspecified) |
| I72.3 | Aneurysm of iliac artery; Dissection of iliac artery |
| I72.8 | Other specified aneurysms (e.g., splenic artery, other visceral artery) |
| I73.9 | Peripheral vascular disease, unspecified |
| I74.01 | Embolism and thrombosis of abdominal aorta, saddle embolus |
| I74.09 | Other embolism and thrombosis of abdominal aorta |
| I74.3 | Embolism and thrombosis of arteries of lower extremity |
| I74.5 | Embolism and thrombosis of iliac artery |
| I75.02 | Atheroembolism of lower extremity |
| I77.6 | Arteritis, unspecified |
ICD-10 Codes for Malignancies, GI Conditions, and Injuries
| ICD-10 Code(s) | Description |
|---|---|
| C17.0-C17.9 | Malignant neoplasm of small intestine (duodenum, jejunum, ileum, unspecified) |
| C22.0, C22.1, C22.8, C22.9 | Malignant neoplasm of liver and intrahepatic bile duct (hepatocellular carcinoma, intrahepatic bile duct carcinoma, etc.) |
| C23 | Malignant neoplasm of gallbladder |
| C24.0, C24.8 | Malignant neoplasm of extrahepatic bile duct; Malignant neoplasm of overlapping sites of biliary tract |
| C26.0, C26.1, C26.9 | Malignant neoplasm of unspecified sites within digestive organs and peritoneum |
| C64.1, C65.1 | Malignant neoplasm of kidney, except renal pelvis; Malignant neoplasm of renal pelvis |
| C78.7 | Secondary malignant neoplasm of liver and intrahepatic bile duct |
| C79.01 | Secondary malignant neoplasm of kidney |
| C7A.097 | Secondary neuroendocrine tumor of liver |
| D09.1 | Carcinoma in situ of other and unspecified urinary organs |
| D30.0, D30.1 | Benign neoplasm of kidney, except renal pelvis; Benign neoplasm of renal pelvis |
| D37.9 | Neoplasm of uncertain behavior of digestive organ, unspecified |
| J81.0 | Acute pulmonary edema, unspecified |
| K55.01-K55.09, K55.1, K55.9 | Acute and chronic vascular disorders of intestine, unspecified vascular disorder of intestine |
| I85.90 | Portal hypertension, unspecified, without esophageal varices |
| K92.0, K92.1, K92.2 | Hematemesis; Melena; Gastrointestinal hemorrhage, unspecified |
| R00.2 | Palpitations (for other symptoms involving cardiovascular system) |
| R31.0, R31.1, R31.2, R31.9 | Gross hematuria, microscopic hematuria, other specified hematuria, unspecified hematuria |
| S35.1xx (with 7th character) | Injury of renal vessel(s) (e.g., S35.10XA – Unspecified injury of renal artery, initial encounter) |
| S36.0xx – S36.9xx (with 7th character) | Injuries to spleen, liver, stomach, small intestine, large intestine, other and unspecified intra-abdominal organs (e.g., S36.112A – Contusion of liver, initial encounter) |
| S39.9xx (with 7th character) | Unspecified injury of abdomen, lower back and pelvis (e.g., S39.91XA – Unspecified injury of abdomen, initial encounter) |
| T14.90 | Injury, unspecified |
| T81.0xx (with 7th character) | Hemorrhage and hematoma complicating a procedure (e.g., T81.00XA – Hemorrhage complicating unspecified procedure, initial encounter) |
| T82.8xx (with 7th character) | Mechanical complication of other vascular devices, implants and grafts (e.g., T82.818A – Embolism due to other vascular prosthetic devices, implants and grafts, initial encounter) |
| T86.1xx (with 7th character) | Complications of transplanted kidney (e.g., T86.11 – Kidney transplant rejection) |
| Z94.0, Z94.4, Z94.83 | Kidney transplant status; Liver transplant status; Pancreas transplant status |
| Z48.21 | Encounter for aftercare following organ transplant |
Note: Many ICD-10 codes, especially for injuries and complications, require a 7th character to specify the encounter type (A for initial, D for subsequent, S for sequela). Always consult the full ICD-10-CM codebook for complete and accurate coding.
Medical Necessity: General CMS Principles for Medicare Billing for Diagnostic Aortograms
While specific National Coverage Determinations (NCDs) might not exist for every angiography procedure, the fundamental principle of medical necessity remains paramount for **Medicare billing for diagnostic aortograms** and renal angiography. Providers must ensure that the diagnostic imaging is reasonable and necessary for the diagnosis or treatment of illness or injury, aligned with accepted standards of medical practice. Clear and comprehensive clinical documentation is essential to support the medical necessity of these procedures. This includes:
- Patient’s signs, symptoms, and medical history.
- Previous diagnostic test results (e.g., ultrasound, CT, MRI) that indicate the need for angiography.
- Clinical indications for which the procedure is being performed (e.g., suspected renal artery stenosis causing hypertension, suspected aortic aneurysm).
- Rationale for choosing angiography over less invasive diagnostic methods.
- The ordering physician’s report must explicitly state the medical necessity.
For more specific guidance, always refer to your local Medicare Administrative Contractor (MAC) policies.
Correct Coding Initiative (CCI) Edits and Modifiers
The Correct Coding Initiative (CCI) promotes correct coding methodologies and prevents improper payment. CCI edits consist of Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUEs). It is crucial to be aware of CCI edits that may bundle certain services when billed together. When services are bundled, they typically cannot be billed separately unless a specific modifier is appropriate.
Understanding and correctly applying modifiers can help bypass CCI edits when distinct procedural services are performed. Key modifiers relevant to abdominal aortography and renal angiography include:
- Modifier -50 (Bilateral Procedure): Used when a procedure is performed bilaterally during the same operative session. For example, if a renal angiography procedure is performed on both kidneys and the CPT code does not already specify a bilateral service (like 36252 or 36254), modifier -50 might be appended to the unilateral code.
- Modifier -59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This modifier is often necessary when multiple procedures are performed that would typically be bundled but are clinically distinct (e.g., catheter placement in a different artery, or a separate patient encounter). Documentation must clearly justify its use.
- Modifier -26 (Professional Component): Used by physicians to bill for the professional component of a diagnostic test, which includes supervision and interpretation.
- Modifier -TC (Technical Component): Used by facilities to bill for the technical component of a diagnostic test, including equipment, supplies, and personnel.
Regularly consulting the latest CCI edits is essential to ensure compliance and prevent claim denials. The **AMA-assn.org** website is a good resource for CPT information.
Clinical Scenarios for Coding
Applying the correct codes can be complex. Here are a few simplified clinical scenarios demonstrating the practical application of **abdominal aortogram CPT codes** and **renal angiography ICD-10** codes:
- Scenario 1: Suspected Renal Artery Stenosis
A 65-year-old patient presents with uncontrolled hypertension and suspected renal artery stenosis. A selective catheterization of the right renal artery is performed for angiography.
CPT Codes: 36251 (Selective catheter placement, renal artery, unilateral) + 75726 (Angiography, renal, radiological supervision and interpretation).
ICD-10 Codes: I15.0 (Renovascular hypertension), I70.1 (Atherosclerosis of renal artery). - Scenario 2: Evaluation of Abdominal Aortic Aneurysm
A 70-year-old patient with a known abdominal aortic aneurysm requires an abdominal aortogram to evaluate its size and extent prior to surgery. Catheterization is performed in the aorta.
CPT Codes: 36200 (Placement of catheter in aorta) + 75625 (Aortography, abdominal, radiological supervision and interpretation).
ICD-10 Codes: I71.4 (Abdominal aortic aneurysm, without rupture). - Scenario 3: Bilateral Renal Artery Evaluation
A patient undergoes bilateral selective renal angiography for evaluation of suspected bilateral renal artery disease.
CPT Codes: 36252 (Selective catheter placement, renal artery, bilateral) + 75726 (Angiography, renal, radiological supervision and interpretation).
ICD-10 Codes: I70.1 (Atherosclerosis of renal artery), I10 (Essential hypertension).
Revenue Codes
Revenue codes are used by facilities to categorize services for billing. While purely advisory in most instances, they help identify the department or service area where the procedure was performed. For abdominal aortography and renal angiography, the following revenue codes are commonly applicable, primarily for outpatient hospital settings (critical for understanding outpatient vs. inpatient distinctions):
- 032X Radiology – Diagnostic – General Classification: This is the most common classification for diagnostic imaging services.
- 033X Radiology – Therapeutic and/or Chemotherapy Administration – General Classification: Less common for purely diagnostic angiography but may apply if therapeutic interventions are performed during the same encounter.
- 034X Nuclear Medicine – General Classification: Not typically used for angiography.
- 035X CT Scan – General Classification: Not typically used for angiography.
- 040X Other Imaging Services – General Classification: Can be used for other diagnostic imaging services not specifically categorized.
- 061X Magnetic Resonance Technology (MRT) – General Classification: Not typically used for angiography.
Always verify the specific requirements and preferred revenue codes with your payer and local fiscal intermediary.
Frequently Asked Questions (FAQs) about Abdominal Aortogram CPT Codes and Renal Angiography ICD-10
Q1: What is the main difference between ICD-9 and ICD-10 codes for these procedures?
A1: The primary difference is specificity. ICD-10-CM codes (effective October 1, 2015) offer a higher level of detail, including laterality, episode of care, and greater clinical information, compared to the more general ICD-9-CM codes. This precision is vital for accurate data collection, epidemiological studies, and billing.
Q2: Can CPT codes for catheter placement and radiological supervision and interpretation be billed separately?
A2: Yes, typically. Catheter placement codes (e.g., 36200, 36251) cover the physician’s work in placing the catheter, while radiological supervision and interpretation codes (e.g., 75625, 75726) cover the physician’s interpretation of the images. These are usually billed together as component services of a complete procedure, but modifier usage might be necessary depending on the clinical context and payer rules.
Q3: What documentation is critical to support medical necessity for these angiograms?
A3: Detailed physician notes justifying the procedure based on patient symptoms, prior diagnostic findings (e.g., abnormal ultrasound, high-risk factors), and the clinical question the angiography aims to answer. Lack of clear documentation is a leading cause of claim denials for procedures like **diagnostic aortograms**.
Q4: Where can I find the most current coding guidelines?
A4: Always consult official sources, including the latest CPT® codebook from the **American Medical Association (AMA)**, the ICD-10-CM codebook, and official **CMS.gov** guidance, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) from your specific Medicare Administrative Contractor (MAC).
Important Disclaimer
The information provided in this guide is for informational purposes only and is not intended as a substitute for professional medical or coding advice. Medical coding guidelines are complex and subject to frequent changes. Users are strongly advised to consult the most current official CMS guidelines, CPT/HCPCS manuals, and ICD-10-CM codebooks (e.g., from **AMA-assn.org**) for specific coding scenarios. Always verify with your local Medicare Administrative Contractor (MAC) policies and other third-party payer guidelines before submitting claims, as coverage and coding rules can vary.
