ICD-10-PCS Coding for Angiography

C. Matheson, RHIA, CCS Medical Coding Leave a Comment

ICD-10-PCS Coding for Angiography

When coding angiography procedures in ICD-10-PCS, a number of variables can make it challenging to get the coding right. For instance, knowing what value a particular type of contrast maps to is necessary to assign codes accurately. To help you make correct character selections when coding angiography the information that follows provides a high level review of each character and the details communicated by the values available for each as well as some of the guidelines and other coding advice that influences the assignment of these codes.

Associated Diagnoses

Angiograms are performed primarily to diagnose vascular disease throughout the body. It’s common to see the diagnoses in the list below as the pre/post-operative diagnosis for angiography procedures.

  • Pain in chest/angina
  • Coronary artery/heart disease (CAD) (CHD)
  • Arterio/atherosclerotic heart disease (ASHD)
  • Ischemic heart disease (IHD)
  • Pain in legs/claudication
  • Peripheral artery/vascular disease (PAD/PVD)
  • Thrombosis/embolism

Purpose/Definition

Angiography is a radiological procedure that uses fluoroscopy, x-ray, CT or MRI to image arteries and veins in relation to vascular obstructions such as atherosclerosis, embolism or thrombus or vascular anomalies. Images are obtained by is inserting a catheter into the vascular system through a puncture in an artery or vein and injecting contrast through the catheter so the vessel can be visualized. Common sites of vascular puncture are the femoral, radial, ulnar and brachial arteries.

Diagnostic Angiogram

Angiography is used to diagnosis vascular disease. Common sites of diagnostic angiograms are the coronary arteries, aorta, ventricles or the heart, carotid or cerebral arteries and the arteries of the leg. However, angiography can be used to detect disease throughout the body. Diagnostic angiogram is often performed immediately preceding a therapeutic procedure such an angioplasty or thrombectomy and when looking for disease in the heart, angiography is often accompanied by a diagnostic heart cath.

ICD-10-PCS Building Blocks

Building an ICD-10-PCS code to correctly report an angiography procedure from the documentation in an imaging study requires knowing what information each character reports. The following are some of the details about what information the values for the 7 characters used to create an ICD-10-PCS angiography code report.

PCS Section and Body System

All angiography codes will come from the “Imaging” section of ICD-10-PCS, but the correct code table will vary based on the value of the Body System character.

Section

Body System

Imaging (B)

Heart (2)

 

Upper Arteries (3)

 

Lower Arteries (4)

 

Veins (5)

 

Imaging Type

In the imaging section of PCS the 3rd character is “Type” not “Root Operation”. The character values for “Type” include:

  • Fluoroscopy – Single plane or biplane real time display of an image developed from the capture of external ionizing radiation on a fluorescent screen. Fluoroscopy is the most common type of imaging for angiography
  • Plain Radiography – Planar display of an image developed from the capture of external ionizing radiation on photographic or photoconductive plate.
  • CT – Computer reformatted digital display of multiplanar images developed from the capture of multiple exposures of external ionizing radiation
  • MRI – computer reformatted digital display of multiplanar images developed from the capture of radiofrequency signals emitted by nuclei in a body site excited with a magnetic field

Note: Ultrasonography is also a “Type” in the Imaging section, but it is not used for angiography.

Body Parts

The body part values are divided by the body system; Heart, Upper Arteries, Lower Arteries and Veins

Some interesting points about the values for the body part character include:

  • Body part values; Heart, Right and Heart, Left include the right and left ventricles
  • Not every body part value is available for every “Type” in the Imaging section of ICD-10-PCS
  • In the imaging section of PCS, unlike arteries, the vein body parts are not divided into tables for upper and lower sites.

Contrast

ICD-10-PCS has character values for 3 types of contrast and a 4th character value of “None” for procedures performed without contrast.

Contrast Type

Example

High osmolar

Hypapaque, Isopaque

Low osmolar

Ominpaque, Isovue

Other Contrast

Visipaque

 

To report angiography procedures where contrast was used, you must know the type of contrast and what contrast character value it maps to. This is a good example of an opportunity to put facility specific coding guidelines to work as recommended in Coding Clinic.

“…Facility coders are encouraged to work with their radiologists to determine which contrast media is being used for imaging, and then develop internal facility specific guidelines identifying the type of contrast in order to code these procedures. For example, a facility may use only low osmolar contrast for imaging studies”.

ICD-10-CM/PCS Coding Clinic, Third Quarter ICD-10 2016 Page: 36 

Qualifiers         

The 6th and 7th character of a PCS angiography code are qualifiers which allow additional explanatory information to be communicated by the code. Some qualifiers and their values are specific to certain imaging “types”. For example, the value of “0” indicates a qualifier of “Unenhanced and Enhanced” for the CT and MRI imaging types but indicates “intraoperative” for the fluoroscopy imaging type. This means qualifier values are not necessarily interchangeable, so the PCS table should always be consulted to determine the correct value to assign.

Imaging Type

Qualifiers

Fluoroscopy (1)

Intraoperative (0)

 

Laser (1)

 

Guidance (A)

Computerized Tomography (CT Scan) (2)

Unenhanced and Enhanced (0)

 

Intravascular Optical Coherence (2)

Magnetic Resonance Imaging (MRI) (3)

Unenhanced and Enhanced (0)

 

ICD-10-PCS Coding Guidelines

  • 11a “Inspection of a body part(s) performed to achieve the objective of a procedure is not coded separately”.

Based on this guidance, only diagnostic angiography is coded and reported. Repeat angiography to “check work” is inherent in the therapeutic procedure and not reported separately.

  • 1b “…Procedural steps necessary to reach the operative site and close the operative site,… are also not coded separately.”

Based on this guideline, in ICD-10-PCS, vascular catheterization is not coded separately as it is a procedural step necessary to reach the operative site. Do not get this confused with CPT coding where in some cases selective catheter placement for angiography is separately reportable.

Of course there is more to coding angiography procedures than was covered here, but knowing what details to look for in the imaging study documentation and what guidelines apply to reporting these procedure is a good start to getting the coding right!

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