Coding Q&A

When is it appropriate to report diagnostic angiography in addition to an intervention?

This answer to this question varies from procedure to procedure throughout the American Medical Association’s (AMA’s) Current Procedural Terminology (2026/CPT®) manual. Some procedures, such as fallopian tube recanalization, have separate codes for the work of the procedure and the work of interpreting the imaging findings (RS&I). Fallopian tube recanalization would be coded with 58345, which describes the work of catheterizing the fallopian tube, and 74742, which describes the work of the radiological supervision and interpretation for the procedure.

However, over the years, the components of some procedures have been bundled to incorporate the work of performing the procedure and the RS&I into a single code. Performing a diagnostic internal carotid angiogram is a good example where the code, 36224, includes the selective catheter placement into the internal carotid artery with angiography and all associated RS&I.

Other codes are less straightforward regarding when to or when not to report RS&I in addition to a procedure. For example, a patient may have had a prior CTA runoff prior to lower extremity revascularization attempt. Is it appropriate to code a diagnostic lower extremity angiogram in addition to the revascularization procedure? The answer is it depends.

Per the 2026 edition of the CPT manual, diagnostic angiography codes should NOT be used with interventional procedures to describe the work of injecting contrast, performing angiography, road mapping or utilizing fluoroscopic guidance for intervention, vessel measurement, etc. If a procedure can only be performed with a catheter contrast and fluoroscopy, then the work associated with catheters contrast and fluoroscopy are already included in the procedure’s description of work: reporting an RS&I code for that work would be inappropriate. Diagnostic codes are for the work of making a diagnosis, not for the work of treating a patient in a catheter-based fashion.

There are cases where diagnostic angiography performed at the time of intervention is separately reported, but these require a provider to be making a new diagnosis. If there is no prior catheter-based angiographic study available (note that Medicare views CTA also as a catheter-based study), then diagnostic angiography can be reported in addition to the intervention if a full diagnostic study is performed AND the decision to intervene is based on the diagnostic imaging. If there is a prior catheter-based angiographic study available, then diagnostic angiography can be reported in addition to the intervention if the patient’s condition with respond to the clinical indication has changed since the previous study OR there is inadequate visualization of the anatomy/pathology OR there is a clinical change during the procedure that requires new evaluation outside the target area of intervention. In each case, a new diagnosis is being made that justifies the reporting of a diagnostic code in addition to the codes for the intervention.

Given these coding guidelines, it is imperative that interventional radiologists continue to provide documentation of available or unavailable prior catheter-based studies or CTAs as well as sufficient documentation of findings or changes that might occur during the procedure which could affect reporting. While it may have once been common practice to report a diagnostic RS&I code with every intervention code, that has been inappropriate practice for many decades now and is considered unbundling.

In situations where a diagnosis is in fact being made and reporting of a 7XXXX series RS&I code is justified, attention should also be given to the judicious use of add-on codes such as 75774, which is to be reported for “each additional vessel studied after basic examination,” however not per vessel selected. The “basic examination” in this case represents the body area included within the base diagnostic code reported, and reporting of 75774 should be limited to the work of interpretation beyond that which is normally included in evaluating that body region.

Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2026/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service.

Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.