With thousands of CPT codes available for different categories, anyone can feel overwhelmed. However, accurately coding procedures is one of the important metrics to ensure timely reimbursements and avoid claim denials. That’s why most healthcare facilities opt to outsource the medical billing and coding to professionals.
But, if you want to handle the financial side of your practice in-house, you can benefit from our extensive library of CPT code guides. We try to explain each code, its intricate guidelines, and best practices in a separate blog.
This guide will cover the CPT code 75716. So, without further ado, let’s start with the details!
CPT Code 75716 – Description
It is a procedural code under the range of diagnostic radiology (imaging) procedures of the aorta and arteries maintained by the American Medical Association (AMA). The 75716 CPT code is used for billing for the radiological supervision and interpretation of angiography’s specific procedure that focuses on the bilateral placement of a catheter into an extremity (arms or legs).
For the unversed, angiography involves X-ray imaging to investigate the blood vessels, and the images generated during this procedure are called angiograms. The healthcare provider may request an angiography because the patient’s condition and the ECG report show signs of coronary heart disease (CHD), such as nausea, shortness of breath, and chest pain.
Scenarios Where CPT Code 75716 is Applicable
The 75716 CPT code can be applied for diagnosing vascular disease, pre-operative planning, and post-operative monitoring. Here are some scenarios for better understanding:
Scenario # 1 – Vascular Disease Diagnosis
If a patient is experiencing peripheral arterial disease (PAD) symptoms during exercise, such as leg numbness or pain, the healthcare practitioner may order a bilateral lower extremity angiogram. The findings of this procedure will help the provider determine if there is any narrowing or blockages in the leg arteries.
Thus, you can report CPT code 75716 for the angiography. However, this is just one example related to diagnosis.
Scenario # 2 – Pre-operative Planning
Let’s assume a scenario where providers are considering performing amputation for a patient due to a vascular disease. Conducting an angiography can help provide insight into irregular blood flow in the affected limb. The findings can help physicians determine whether or not any alternate treatment options are available for the patient. While billing angiography, you can report the 75716 CPT code.
Scenario # 2 – Post-operative Monitoring
Another scenario where you can apply CPT code 75716 is post-operative monitoring. For example, after angioplasty or percutaneous coronary intervention (PCI), where a stent is placed to open a blocked artery, a follow-up angiography can help monitor the patency or related issues.
Accurate Application of Modifiers with CPT Code 75716
The need for a modifier while reporting the 75716 CPT code depends on the insurance company’s billing requirements and the procedure’s specific circumstances. For instance, you may be required to include a modifier to specify the complexity of angiography or additional services performed.
We have compiled a list of potential modifiers healthcare providers can utilize while billing the CPT code 75716. Understanding these modifiers will help ensure coding specificity for accurate reimbursements.
- Modifier TC (Technical Component) – When you append this modifier, it informs the payer that only the technical component is being billed, i.e., the technician’s work and equipment use.
- Modifier 26 (Professional Component) – If you want to bill only the professional component (interpretation of the imaging results by the provider), add this modifier with the CPT code 75716. It signifies to the payer that the physician’s knowledge was utilized in interpreting the angiogram and is being billed separately.
- Modifier 50 (Bilateral Procedure) – Since the angiography was performed on both arms or legs, the claim should contain modifier 50 with the 75716 CPT code, as the complexity of the procedure will affect the final reimbursement amount.
- Modifier 59 (Distinct Procedural Services) – You should append this modifier to inform the payer that a service or procedure is distinct from the other service performed on the same day to mitigate the risk of claim duplication and resulting denial.
- Modifier 76 (Repeated Procedure by Same Provider) – In case the angiography is required to be repeated by the same physician on the same day, use this modifier to avoid payment delays.
- Modifier 77 (Repeated Procedure by Different Provider) – Use this modifier if the angiography was repeated by another physician on the same day.
- Modifier 91 (Repeated Angiography for Clinical Reasons) – If the angiography is repeated for clinical reasons, you should add this modifier with CPT code 75716. However, it is a rare situation for imaging procedures.
You may find all these modifiers overwhelming as they add to the coding complexities. However, accurately appending modifiers is crucial for rightful payment collection. Thus, we recommend outsourcing medical coding services if you cannot stay current with the coding guidelines.
CPT Code 75716 vs. 75630 – Key Differences
Both codes are related to angiography and come under the same code range defined by the AMA for diagnostic radiology procedures. However, some distinctions must be considered while using them. Here’s a table to give you a better understanding of the differences in both procedural codes:
| Considerations | CPT Code 75716 | CPT Code 75630 |
|---|---|---|
| What does it entail? | It covers the interpretation and supervision of bilateral angiography of an extremity. | It includes the professional and technical components of radiologic imaging of the abdominal aorta and both iliofemoral arteries of the lower extremities. |
| When to report it? | You can use this CPT code to bill the imaging of both legs or both arms through a catheter placed in each extremity. | You should report this CPT code when the abdominal aorta and iliofemoral arteries of the lower extremities are imaged and the results are interpreted. |
| What is the main focus of the procedure? | The aorta and arteries in the arms and legs. | Iliac arteries and abdominal aorta in the lower extremities. |
As gathered from the table above, the main distinction in both the CPT codes is in terms of the focus area for diagnostic imaging. The CPT code 75716 requires catheter placement in both legs/arms to capture the images of the blood vessels, while CPT 75630 requires catheter placement in the legs for radiologic imaging of the abdominal aorta and both the iliofemoral arteries.
Best Practices for Billing CPT Code 75716
You should follow these best practices for accurately reporting the 75716 CPT code and prevent denials, audits, or financial penalties:
- Educate your billing staff in payer-specific and procedure-specific documentation requirements.
- Train your staff on coding guidelines to ensure they utilize accurate codes and append the modifiers where required to provide maximum specificity to the payer.
- Provide additional documentation for services or procedures performed during the same encounter.
- Leverage the electronic health records (EHR) system for a seamless billing process and minimize the risk of errors in the claim.
- Regularly conduct internal audits to identify issues with the medical billing process and communicate with the insurance company to find areas for improvement.
Bottom Line
Let’s quickly recap what we learned in this guide. We shared the 75716 CPT code description, some practical scenarios where it applies, and a list of appropriate modifiers based on the specific circumstances.Since many healthcare practitioners confuse CPT code 75716 with 75630, we discussed the distinctions between both codes to help you submit a clean claim every time. Before wrapping up, a reminder about who we are! At MediBill MD, we serve more than 45 specialties across all 50 states of the US with our revenue cycle management (RCM), medical credentialing, and medical billing services.
