LCD Reference Article Billing and Coding Article

Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography

A56682

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56682
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
10/13/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

 

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35092, Diagnostic Abdominal Aortography and Renal Angiography. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

CMS issued HCPCS code G0278 for femoral or iliac angiography when done at the time of coronary angiography.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
032X Radiology - Diagnostic - General Classification
033X Radiology - Therapeutic and/or Chemotherapy Administration - General Classification
040X Other Imaging Services - General Classification
N/A

CPT/HCPCS Codes

Group 1

(6 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

The following CPT code associated with the services outlined in this Billing and Coding Article will not have diagnosis limitations applied at this time: 36200.

Group 1 Codes
Code Description
36245 Ins cath abd/l-ext art 1st
36246 Ins cath abd/l-ext art 2nd
36247 Ins cath abd/l-ext art 3rd
36248 Ins cath abd/l-ext art addl
75625 Contrast exam abdominl aorta
75726 Artery x-rays abdomen

Group 2

(4 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
36251 Ins cath ren art 1st unilat
36252 Ins cath ren art 1st bilat
36253 Ins cath ren art 2nd+ unilat
36254 Ins cath ren art 2nd+ bilat

Group 3

(2 Codes)
Group 3 Paragraph

N/A

Group 3 Codes
Code Description
75630 X-ray aorta leg arteries
G0278 Iliac art angio,cardiac cath
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(201 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT Codes: 36245, 36246, 36247, 36248, 75625, and 75726.

Group 1 Codes
Code Description
C22.0 Liver cell carcinoma
C22.1 Intrahepatic bile duct carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C22.8 Malignant neoplasm of liver, primary, unspecified as to type
C22.9 Malignant neoplasm of liver, not specified as primary or secondary
C7B.02 Secondary carcinoid tumors of liver
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
D25.0 Submucous leiomyoma of uterus
D25.1 Intramural leiomyoma of uterus
D25.2 Subserosal leiomyoma of uterus
I15.0 Renovascular hypertension
I70.0 Atherosclerosis of aorta
I70.1 Atherosclerosis of renal artery
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.761 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791 Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792 Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793 Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I71.60 Thoracoabdominal aortic aneurysm, without rupture, unspecified
I71.61 Supraceliac aneurysm of the thoracoabdominal aorta, without rupture
I71.62 Paravisceral aneurysm of the thoracoabdominal aorta, without rupture
I72.3 Aneurysm of iliac artery
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.5 Embolism and thrombosis of iliac artery
I77.1 Stricture of artery
I77.4 Celiac artery compression syndrome
I77.811 Abdominal aortic ectasia
I77.812 Thoracoabdominal aortic ectasia
I79.0 Aneurysm of aorta in diseases classified elsewhere
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
K55.011 Focal (segmental) acute (reversible) ischemia of small intestine
K55.012 Diffuse acute (reversible) ischemia of small intestine
K55.021 Focal (segmental) acute infarction of small intestine
K55.022 Diffuse acute infarction of small intestine
K55.029 Acute infarction of small intestine, extent unspecified
K55.031 Focal (segmental) acute (reversible) ischemia of large intestine
K55.032 Diffuse acute (reversible) ischemia of large intestine
K55.041 Focal (segmental) acute infarction of large intestine
K55.042 Diffuse acute infarction of large intestine
K55.049 Acute infarction of large intestine, extent unspecified
K55.1 Chronic vascular disorders of intestine
K55.21 Angiodysplasia of colon with hemorrhage
K91.61 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating a digestive system procedure
K91.62 Intraoperative hemorrhage and hematoma of a digestive system organ or structure complicating other procedure
K91.840 Postprocedural hemorrhage of a digestive system organ or structure following a digestive system procedure
K91.841 Postprocedural hemorrhage of a digestive system organ or structure following other procedure
K91.870 Postprocedural hematoma of a digestive system organ or structure following a digestive system procedure
K91.871 Postprocedural hematoma of a digestive system organ or structure following other procedure
K92.1 Melena
K92.2 Gastrointestinal hemorrhage, unspecified
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms
Q27.33 Arteriovenous malformation of digestive system vessel
Q27.39 Arteriovenous malformation, other site
Q28.8 Other specified congenital malformations of circulatory system
S35.01XA Minor laceration of abdominal aorta, initial encounter
S35.01XD Minor laceration of abdominal aorta, subsequent encounter
S35.01XS Minor laceration of abdominal aorta, sequela
S35.02XA Major laceration of abdominal aorta, initial encounter
S35.02XD Major laceration of abdominal aorta, subsequent encounter
S35.02XS Major laceration of abdominal aorta, sequela
S35.09XA Other injury of abdominal aorta, initial encounter
S35.09XD Other injury of abdominal aorta, subsequent encounter
S35.09XS Other injury of abdominal aorta, sequela
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
S36.114A Minor laceration of liver, initial encounter
S36.114D Minor laceration of liver, subsequent encounter
S36.114S Minor laceration of liver, sequela
S36.115A Moderate laceration of liver, initial encounter
S36.115D Moderate laceration of liver, subsequent encounter
S36.115S Moderate laceration of liver, sequela
S36.116A Major laceration of liver, initial encounter
S36.116D Major laceration of liver, subsequent encounter
S36.116S Major laceration of liver, sequela
S36.118A Other injury of liver, initial encounter
S36.118D Other injury of liver, subsequent encounter
S36.118S Other injury of liver, sequela

Group 2

(48 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT Codes: 36251, 36252, 36253, and 36254.

Group 2 Codes
Code Description
C64.1 Malignant neoplasm of right kidney, except renal pelvis
C64.2 Malignant neoplasm of left kidney, except renal pelvis
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
D17.71 Benign lipomatous neoplasm of kidney
D30.01 Benign neoplasm of right kidney
D30.02 Benign neoplasm of left kidney
D30.11 Benign neoplasm of right renal pelvis
D30.12 Benign neoplasm of left renal pelvis
I10 Essential (primary) hypertension
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I1A.0 Resistant hypertension
I70.1 Atherosclerosis of renal artery
I72.2 Aneurysm of renal artery
N26.2 Page kidney
N28.0 Ischemia and infarction of kidney
Q27.1 Congenital renal artery stenosis
Q27.2 Other congenital malformations of renal artery
Q27.34 Arteriovenous malformation of renal vessel
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.21 Asymptomatic microscopic hematuria
R31.29 Other microscopic hematuria
R33.8 Other retention of urine
R94.4 Abnormal results of kidney function studies
S35.411A Laceration of right renal artery, initial encounter
S35.411D Laceration of right renal artery, subsequent encounter
S35.411S Laceration of right renal artery, sequela
S35.412A Laceration of left renal artery, initial encounter
S35.412D Laceration of left renal artery, subsequent encounter
S35.412S Laceration of left renal artery, sequela
S35.491A Other specified injury of right renal artery, initial encounter
S35.491D Other specified injury of right renal artery, subsequent encounter
S35.491S Other specified injury of right renal artery, sequela
S35.492A Other specified injury of left renal artery, initial encounter
S35.492D Other specified injury of left renal artery, subsequent encounter
S35.492S Other specified injury of left renal artery, sequela

Group 3

(19 Codes)
Group 3 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS/CPT Codes: 75630 and G0278.

Group 3 Codes
Code Description
I70.0 Atherosclerosis of aorta
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I71.40 Abdominal aortic aneurysm, without rupture, unspecified
I71.41 Pararenal abdominal aortic aneurysm, without rupture
I71.42 Juxtarenal abdominal aortic aneurysm, without rupture
I72.4 Aneurysm of artery of lower extremity
I73.89 Other specified peripheral vascular diseases
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
S35.511A Injury of right iliac artery, initial encounter
S35.511D Injury of right iliac artery, subsequent encounter
S35.511S Injury of right iliac artery, sequela
S35.512A Injury of left iliac artery, initial encounter
S35.512D Injury of left iliac artery, subsequent encounter
S35.512S Injury of left iliac artery, sequela
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description
032X Radiology - Diagnostic - General Classification
033X Radiology - Therapeutic and/or Chemotherapy Administration - General Classification
040X Other Imaging Services - General Classification
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/13/2023 R10

Article revised and published on 11/30/2023 effective for dates of service on and after 10/13/2023. The following ICD-10-CM codes have been added to Group 1 codes in response to an inquiry: C22.1, C22.2, C22.3, C22.4, and C22.7.

10/01/2023 R9

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has been added to the article: Group 2: I1A.0. The following ICD-10-CM codes have been revised: Group 1: I71.61, I71.62.

10/01/2022 R8

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: I71.40, I71.41, I71.42, I71.60, I71.61, I71.62 to the ‘Group 1 Codes’, and I71.40, I71.41, and I71.42 to the ‘Group 3 Codes’. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: I71.4 and I71.6 from ‘Group 1 Codes’, and I71.4 from the ‘Group 3 Codes’.

02/25/2022 R7

Article revised and published on 05/05/2022 effective for dates of service on and after 02/25/2022 in response to an inquiry. ICD-10 code I74.3 was added to the ‘ICD-10-CM Codes that Support Medical Necessity’ section for ‘Group 3 Codes’.

01/19/2022 R6

Article revised and published on 03/24/22 effective for dates of service on and after 01/19/22. ICD-10-CM codes D25.0, D25.1, D25.2, and N40.1 were added to ‘Group 1 Codes’ as a response to inquiries. 

11/12/2021 R5

Article revised and published on 02/17/2022 effective for dates of service on and after 11/12/2021. ICD-10-CM code D17.71 has been added to the Group 2 ICD-10-CM codes that support medical necessity. This revision is in response to an inquiry.

08/19/2021 R4

Article revised and published on 10/28/2021 effective for dates of service on and after 08/19/2021. ICD-10-CM codes I70.238 and I70.248 have been added to groups 1 and 3 in response to an inquiry. The paragraph regarding NCCI guidelines has been deleted from the Article Text section. Minor formatting changes have been made throughout the article.

11/02/2020 R3

Article revised and published on 07/08/2021 effective for dates of service on and after 11/02/2020. ICD-10-CM code R33.8 has been added to the ICD-10-CM code group 2 in response to an inquiry. Minor formatting changes have been made throughout the article.

02/13/2020 R2

Article revised and published on 02/13/2020 effective for dates of service on and after 10/24/2019. ICD-10-CM codes I70.0, I70.201, I70.202 and I70.203 have been added to the group 1 diagnosis codes.

11/07/2019 R1

Article revised and published on 11/07/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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