Coding Tip: Lower Extremity Endovascular Revascularization
This Coding Tip was updated on 12/10/2018
CPT codes 37220-37235 are reported for interventions of the lower extremities for treatment of occlusive disease and include angioplasty, atherectomy and stent placements. There are three vascular territories for coding purposes in the lower extremities. They are the iliac territory, the femoral/popliteal territory and the tibial/peroneal territory. There is a hierarchy that must be followed when reporting these interventions which is a stent with atherectomy supersedes atherectomy, which supersedes stent, which supersedes angioplasty when performed in the same vessel territory.
Some coding tips to remember:
Only one intervention can be reported for the femoral/popliteal territory, which includes the common femoral, profunda, superficial femoral and popliteal arteries. Because only one intervention can be reported it would be appropriate to combine all interventions performed in this territory for the same leg together, and report the most complex intervention only. Some examples are:
- Atherectomy and angioplasty were performed on the right superficial femoral artery and a stent was placed in the right common femoral artery. Since only one intervention can be reported for this territory it would be appropriate to combine the interventions together and report the more complex code of 37227 which captures the stent and atherectomy in the femoral/popliteal territory.
- Atherectomy was performed on the left superficial femoral artery and a stent was placed in the left popliteal artery. Code one instance of 37227 which captures the stent and atherectomy performed within the unilateral femoral/popliteal territory.
Bridging lesions are coded as a single vessel intervention even when the lesion extends across two separate vascular territories. The current recommendation is to report the intervention to the most distal territory intervened upon. For example:
- A stent was placed in a lesion that extended from the distal right external iliac artery into the right common femoral artery. Report only one intervention and use the most distal vascular territory treated, CPT code 37226 for the femoral/popliteal artery stent placement.
- An angioplasty was performed on a bridging lesion involving the left below-knee popliteal artery that extended down into the left tibioperoneal trunk artery. Report only the most distal vessel intervention which is the tibioperoneal trunk angioplasty, CPT code 37228.
The tibial/peroneal territory includes only three vessels that are considered separate for reporting purposes. These three vessels are the anterior tibial, posterior tibial and peroneal artery. The tibioperoneal trunk is considered part of any distal intervention in the posterior tibial or peroneal artery. It is not considered a part of the anterior tibial artery and if separate and distinct lesions are treated in the anterior tibial artery and tibioperoneal trunk two interventions are reported. Some examples of tibial/peroneal territory interventions are:
- Atherectomy was performed in the distal left anterior tibial artery and a stent was placed in the left tibioperoneal trunk for a 90% stenosis. Report the more complex intervention, based on the hierarchy for these codes, in the anterior tibial artery as the initial service with CPT code 37229 and the stent placement in the tibioperoneal trunk as a separate intervention using add on CPT code 37234.
- Atherectomies were performed on separate and distinct lesions in the left tibioperoneal trunk, anterior tibial and posterior tibial arteries. Report only two interventions for this scenario since the tibioperoneal trunk intervention is included in the posterior tibial intervention. The correct CPT codes would be one instance of CPT code 37229 and one instance of add on CPT code 37233 for the additional atherectomy in the tibial/peroneal territory.
The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
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In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
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