Diagnosis Coding for Renal Angiography

Question:

What would be the appropriate ICD-10-CM code if the patient comes for renal artery bleeding and the physician studies renal angiogram and found no active extravasation? Diagnosis R58 is not payable diagnosis as per LCD policy for CPT 36253.  Can  you provide some guidance?

Answer:

When renal angiography is performed for suspected renal artery bleeding and no active extravasation is identified, the diagnosis must accurately reflect the clinical indication and intent of the study. Because nonspecific symptom codes such as diagnosis code R58 do not define an anatomical site or etiology, they often do not support the medical necessity of the procedure.

The order and final impression should clearly document the suspected or underlying cause prompting the angiogram (for example, postprocedural hemorrhage or renal injury). If documentation is unclear or a specific diagnosis cannot be identified, it is appropriate to query the provider to determine the most accurate diagnosis supporting medical necessity. When no suitable ICD-10 code can be established after clarification, append the appropriate G modifier based on ABN status to indicate that medical necessity may not be supported for the service.

*This response is based on the best information available as of 02/05/26.