Billing for both an angiogram and catheter placement for a failed access site performed during a left heart catheterization (LHC)

Q.

Can we bill for both an angiogram and catheter placement for a failed access site performed during a Left Heart Catheterization (LHC)? For example, right radial artery (RRA) access was obtained but we could not navigate the wire to the right subclavian. Right brachial artery angiography was subsequently performed through the diagnostic catheter showing tortuosity and the vessel size was small, and a decision was made to pursue a right femoral artery access. Could we submit CPT codes 36140-59 and 75710-59 with the LHC CPT code of 93458?

A.

Yes, it is appropriate to submit CPT codes 36140-59 and 75710-59 along with the appropriate heart cath/coronary angiogram code(s) for what was finally performed. If the doctor did not do a brachial artery angiogram, but just removed the catheter after not being able to get through, you would only report CPT code 36140—59.