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10/20/2021Cracking the IR Code: Tips for MasteringLower Extremity InterventionsPresented byStacie L. Buck, RHIA, CCS‐P, RCC, RCCIR, CIRCCPresident & Senior ConsultantRadRxRadRx“Your Prescription for Accurate Coding & Reimbursement”1SpeakerStacie L. Buck, RHIA, CCS‐P, RCC, RCCIR, CIRCC Stacie L. Buck, RHIA, CCS‐P, RCC, RCCIR,CIRCC is President & Senior Consultant atRadRx in Stuart, FL. Stacie is a nationallysought out speaker who providesconsulting services to providers ofdiagnostic and interventional radiologyservices. She is the author of the bookCracking the IR Code: Your ComprehensiveGuide to Mastering InterventionalRadiology Coding and creator ofMastering Interventional Radiology &Cardiology Online Education Program.Stacie has 29 years experience inhealthcare, 21 of which she has spentworking in radiology. She is a nationallysought out speaker who has presentedwell over 200 coding seminars.ContactEmail: info@radrx.comWebsite: www.radrx.comRadRx“Your Prescription for Accurate Coding & Reimbursement”221
10/20/2021Disclaimer Every effort has been made to provide accurate and up‐to‐date information; however, the presenter is not responsible inany way for any form of information provided that may be inerror, or outdated, or have any other adverse effect.Furthermore, individual private payer guidelines andindividual MAC policy may differ from what is suggested inthis presentation. The content contained herein, is based onofficial coding guidelines, advice published by ACR, and CMSNational Policies. All attendees are strongly encouraged toverify that the information presented is accurate and correct.Additionally, all attendees are responsible for verifying thespecific payer guidelines for their payers.RadRx“Your Prescription for Accurate Coding & Reimbursement”33DIAGNOSTIC ANGIOGRAPHY &THERAPEUTIC INTERVENTIONSRadRx“Your Prescription for Accurate Coding & Reimbursement”42
10/20/2021Therapeutic Interventions & DiagnosticAngiography Diagnostic angiography codes should NOT beused to report services already capturedthrough the reporting of a therapeutictranscatheter RS&I code, including:– contrast injections, angiography/venography and fluoroscopicguidance– vessel measurement– roadmapping– completion angiography/venography (except in thosecircumstances when code 75898 is applicable)– Post‐angioplasty/stent angiography ‐ this work is captured inthe interventional radiologic supervision and interpretationcode(s)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.5Therapeutic Interventions & DiagnosticAngiography Diagnostic angiography performed at the timeof an interventional procedure is separatelyreportable if:– No prior catheter‐based angiographic study* isavailable and a full diagnostic study is performed,and the decision to intervene is based on thediagnostic study, OR RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.63
10/20/2021Therapeutic Interventions & DiagnosticAngiography Diagnostic angiography performed at the timeof an interventional procedure is separatelyreportable if:– A prior study is available, but as documented in the medicalrecord: The patient's condition with respect to the clinicalindication has changed since the prior study, OR There is inadequate visualization of the anatomy and/orpathology, OR There is a clinical change during the procedure thatrequires new evaluation outside the target area ofinterventionRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.7Therapeutic Interventions & DiagnosticAngiography Diagnostic angiography performed at the timeof an interventional procedure is separatelyreportable if:– Diagnostic angiography performed at a separatesetting from an interventional procedure isseparately reported.– Diagnostic angiography performed at the time ofan interventional procedure is NOT separatelyreportable if it is specifically included in theinterventional code descriptor.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.84
10/20/2021Diagnostic Angiography withTherapeutic Interventions NCCI Chapter 5, D.13 & Chapter 9, D.4– A diagnostic angiogram/venogram may be separatelyreportable with modifier 59 if it satisfies "CPT Manual"guidelines, national Medicare guidelines, and localMedicare Administrative Contractor guidelines.– If the code descriptor for a vascular procedure specificallyincludes diagnostic angiography, the provider shall notseparately report a diagnostic angiography code.RadRx“Your Prescription for Accurate Coding & Reimbursement”9Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.9Diagnostic Angiography withTherapeutic Interventions NCCI Chapter 5, D.13 & Chapter 9, D.4– A second diagnostic angiogram may not be reportedunless medically reasonable and necessary to repeat thestudy to further define the anatomy and pathology.– Prior fluoroscopic OR computed tomographic imagingRadRx“Your Prescription for Accurate Coding & Reimbursement”10Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.105
10/20/2021Diagnostic Angiography withTherapeutic Interventions NCCI Chapter 5, D.13 & Chapter 9, D.4– Report the repeat angiogram with modifier 59 orXU. If it is medically reasonable and necessary torepeat only a portion of the diagnostic angiogram,append modifier 52 in addition to modifier 59 orXU to the angiogram CPT code.– The provider shall not report a second angiogramfor the dye injections necessary to perform theopen or percutaneous intravascular interventionalprocedure.RadRx“Your Prescription for Accurate Coding & Reimbursement”11Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.11Documentation Examples “Diagnostic abdominal aortogram with iliac angiogram withpossible intervention and bilateral lower extremity angiogram areplanned to confirm presence of hemodynamically significantstenosis and to further define anatomical location and morphologyof iliac stenosis, as well as to evaluate for additional inflow oroutflow disease.” “Recent CTA (no images available, only written report) shows rightcommon iliac stenosis. Diagnostic abdominal aortogram with iliacangiogram with possible intervention and right lower extremityangiogram are planned to confirm presence of hemodynamicallysignificant stenosis and to further define anatomical location andmorphology of iliac stenosis, as well as to evaluate for additionalinflow or outflow disease.”RadRx“Your Prescription for Accurate Coding & Reimbursement”12Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.126
10/20/2021Source: Buck, Stacie L. Cracking the IR Code: Your Comprehensive Guide to Mastering Interventional Radiology Coding. RadRx, 2021 ed.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.13ANGIOPLASTYRadRx“Your Prescription for Accurate Coding & Reimbursement”147
10/20/2021Arterial Angioplasty37246 & 37247 37246 Transluminal balloon angioplasty (except lowerextremity artery(ies) for occlusive disease, intracranial,coronary, pulmonary, or dialysis circuit), open orpercutaneous, including all imaging and radiologicalsupervision necessary to perform the angioplasty withinthe same artery; initial artery 37247 Transluminal balloon angioplasty (except lowerextremity artery(ies) for occlusive disease, intracranial,coronary, pulmonary, or dialysis circuit), open orpercutaneous, including all imaging and radiologicalsupervision necessary to perform the angioplasty withinthe same artery; each additional artery (List separately inaddition to code for primary procedure)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.15Arterial Angioplasty37246 & 37247 Assigned for angioplasty of upper extremity, visceral,and renal arteries; lower extremity used for clinicalindications other than occlusive disease Angioplasty codes are assigned one time pervessel/lesion treated– Multiple dilations of the same vessel– Multiple lesions in the same vessel– Bridging lesionsRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.168
10/20/2021Arterial Angioplasty37246 & 37247 Code 37246 is reported for the initial vesseltreated, 37247 reported for each additionalvessel treated.– RS&I is bundled, there are no correspondingRS&I codes. Angioplasty is bundled with stent placementwhen performed in the same vessel unlessangioplasty is performed in a separate anddistinct vessel. Codes 37246 & 37247 bundled with 37220‐37235 when performed in the same vessel.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.17Angioplasty 37246 & 37247:Components Reported Separately Catheterization Codes (36140, 36200, 36245‐36248, 36215‐36218) Diagnostic Angiography when criteria is met Ultrasound guidance for vascular access( 76937) Closure of arteriotomy (G0269 ‐ facility) Intravascular Ultrasound ( 37252, 37253) Moderate Sedation (99151‐99157) Other Therapeutic InterventionsRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.189
10/20/2021STENTRadRx“Your Prescription for Accurate Coding & Reimbursement”19Arterial Stent 37236 & 37237 37236 Transcatheter placement of an intravascular stent(s) (exceptlower extremity artery(ies) for occlusive disease, cervical carotid,extracranial vertebral or intrathoracic carotid, intracranial, orcoronary), open or percutaneous, including radiological supervisionand interpretation and including all angioplasty within the samevessel, when performed; initial artery 37237 Transcatheter placement of an intravascular stent(s) (exceptlower extremity artery(ies) for occlusive disease, cervical carotid,extracranial vertebral or intrathoracic carotid, intracranial, orcoronary), open or percutaneous, including radiological supervisionand interpretation and including all angioplasty within the samevessel, when performed; each additional artery (List separately inaddition to code for primary procedure)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.2010
10/20/2021Arterial Stent 37236 & 37237 Assigned for arterial stent placement, EXCEPT forlower extremity arteries for occlusive disease,cervical carotids, extracranial vertebral, intrathoraciccarotid, intracranial or coronary– In lower extremity, treatment of pseudoaneurysm,aneurysm Stent codes are assigned one time per vessel/lesiontreated– Multiple stents (overlapping) same vessel– Multiple lesions in the same vessel– Bridging lesionsRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.21Arterial Stent 37236 & 37237 Code 37236 is reported for the initial vessel treated, 37237 reported for each additional vessel treated.– RS&I is bundled, there are no corresponding RS&Icodes Angioplasty is bundled with stent placement whenperformed in the same vessel unless angioplasty isperformed in a separate and distinct vessel– Codes 37236 & 37237 bundled with 37220‐37235when performed in the same vessel.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx all rights reserved. Unauthorized distribution is prohibited.2211
10/20/2021Stent 37236 & 37237:Components Reported Separately Catheterization Codes (36140, 36200, 36245‐36248, 36215‐36218) Diagnostic Angiography when criteria is met Ultrasound guidance for vascular access( 76937) Intravascular Ultrasound ( 37252, 37253) Moderate Sedation (99151‐99157) Other Therapeutic Interventions– Angioplasty in separate and distinct vesselRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.23LOWER EXTREMITYREVASCULARIZATION: PTA, STENT,ATHERECTOMYRadRx“Your Prescription for Accurate Coding & Reimbursement”2412
10/20/2021Lower Extremity Revascularization37220‐37235 Assigned for angioplasty, stent and atherectomyof lower extremity arteries for treatment ofocclusive disease– Lower extremity revascularization codes arebroken down into three distinct vascularterritories for coding purposes: Iliac: common iliac, internal iliac and external iliac Femoral/popliteal: common femoral, superficialfemoral, deep femoral and popliteal Tibial/peroneal: anterior tibial, posterior tibial,peroneal and tibioperoneal trunkRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.25Lower Extremity Revascularization37220‐37235 Codes are reported one time per vessel treated withthe exception of the femoral/popliteal territory. Codes are unilateral, therefore a primary code isreported for each side.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.2613
10/20/2021Bundled Components:37220‐37235 Access to vessel Catheterization codes for the vascular territory for whichtherapeutic intervention is being performed Traversing the lesion Radiological supervision & interpretation Guidance Embolic protection Completion angiography Closure of arteriotomyRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.27Components Reported Separately:37220‐37235 Diagnostic Angiography when criteria is metUltrasound guidance for vascular access ( 76937)Intravascular Ultrasound ( 37252, 37253)Moderate Sedation (99151‐99157)Other Therapeutic InterventionsRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.2814
10/20/2021Lower Extremity Interventions: PotentialCoding Errors Not choosing the correct therapeutic code– 37220 – 37235 vs. 37236 ‐37239 for clinicalindication Unbundling– 36245 ‐36248 w/ 37220 ‐37235– Unbundling 37186 w/ 37220 ‐37235 Not coding per vessel/per territory– Bridging lesions– Multiple interventions in same vessel/territoryRadRx“Your Prescription for Accurate Coding & Reimbursement”29Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.29Lower Extremity Interventions:Choosing the Correct Codes Angioplasty & Stent– 37220 – 37235 Occlusive disease Catheter placement bundled– 37236 – 37237 Non‐occlusive disease Catheter placement not bundledRadRx“Your Prescription for Accurate Coding & Reimbursement”30Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.3015
10/20/2021Lower Extremity Revascularization:Choosing the Correct Code(s) Determine the following for each vascular territory:– Each vessel treated– Intervention(s) performed in each vessel– Most extensive procedure performed Determines the primary CPT code for each territory The Society for Interventional Radiology (SIR) hasestablished the following hierarchy to determine themost extensive tent with AtherectomyRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.31Lower Extremity Revascularization:Iliac Territory 37220 Revascularization, endovascular, open or percutaneous,iliac artery, unilateral, initial vessel; with transluminalangioplasty 37221 Revascularization, endovascular, open or percutaneous,iliac artery, unilateral, initial vessel; with transluminal stentplacement(s), includes angioplasty within same vessel, whenperformed. 37222 Revascularization, endovascular, open or percutaneous,iliac artery, each additional ipsilateral Iliac vessel; withtransluminal angioplasty (List separately in addition to code forprimary procedure). 37223 Revascularization, endovascular, open or percutaneous,iliac artery, each additional ipsilateral iliac vessel; withtransluminal stent placement(s), includes angioplasty within thesame vessel, when performed (List separately in addition to codefor primary procedure).RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.3216
10/20/2021Lower Extremity Revascularization:Iliac Territory Each artery is considered a separate vessel for codingpurposes– Common iliac– Internal iliac– External iliacRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.33Lower Extremity Revascularization:Iliac Territory Up to 3 codes may be reported for thisterritory– 1 primary– Up to 2 add‐on codes Atherectomy of the iliacs is not included inthis code range– Report iliac atherectomy with 0238T in addition tolower extremity revascularization codesRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.3417
10/20/2021Atherectomy 0234T – 0238T 0234T Transluminal peripheral atherectomy, open or percutaneous,including radiological supervision and interpretation; renal artery,each vessel 0235T Transluminal peripheral atherectomy, open or percutaneous,including radiological supervision and interpretation; visceral artery,each vessel 0236T Transluminal peripheral atherectomy, open or percutaneous,including radiological supervision and interpretation; aorta 0237T Transluminal peripheral atherectomy, open or percutaneous,including radiological supervision and interpretation;brachiocephalic trunk and branches, each vessel 0238T Transluminal peripheral atherectomy, open or percutaneous,including radiological supervision and interpretation; iliac artery,each vesselRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.35Atherectomy 0238T Assigned for atherectomy of the iliac arteries Atherectomy of other lower extremity arteries isreported with 37225, 37227, 37229, 37231, 37233,37235 Code 0238T is reported for each vessel treated– RS&I is bundled, there are no corresponding RS&IcodesRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.3618
10/20/2021Components Reported Separately:Atherectomy 0238T Catheterization CodesDiagnostic Angiography when criteria metUltrasound guidance for vascular access ( 76937)Closure of arteriotomy (G0269 ‐ facility)Intravascular Ultrasound ( 37252, 37253)Moderate Sedation (99151‐99157)Other Therapeutic InterventionsRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.37Atherectomy:NCCI Manual Chapter 5, D.27 Thrombectomy of thrombus in the vascularterritory of a diseased artery is inherent in thework for an atherectomy procedure. CPT code37186 (Secondary percutaneous transluminalthrombectomy) shall not be reported for removalof such thrombus. For example, if a physicianperforms a lower extremity endovascularrevascularization atherectomy, removal of anythrombus from the vascular territory of the vesseltreated with atherectomy is not separatelyreportable.RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.3819
10/20/2021Coding Scenario #1 Access is gained at the right common femoral artery and thecatheter is advanced over the aortic bifurcation into the leftcommon iliac artery for diagnostic imaging. Atherectomy isperformed of the left external iliac artery. Clinical indication isocclusive disease.– Atherectomy code: 0238T– Catheterization code: 36246– Diagnostic imaging code: 75710(59)LTRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.39Coding Scenario #2 Access is gained at the right common femoral artery and thecatheter is advanced into the abdominal aorta for anaortogram and bilateral runoff. Following diagnostic imaging,angioplasty of the left common iliac is performed, followedby atherectomy of the left external iliac artery. Clinicalindication is occlusive disease.––––Atherectomy code: 0238T(LT)Revascularization code: 37220(LT)Catheterization code: BundledDiagnostic imaging code: 75630(59)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.4020
10/20/2021Coding Scenario #3 Access is gained at the right common femoral artery and thecatheter is placed at the origin of the left common iliac fordiagnostic imaging of the left lower extremity. Followingdiagnostic imaging, angioplasty of the two separate lesions isperformed – one in the left common iliac and another in theleft external iliac. Following angioplasty, a stent is placed inthe left external iliac artery. Clinical indication is occlusivedisease.– Revascularization codes: 37221, 37222– Catheterization codes: Bundled– Diagnostic imaging codes: 75710(59)LTRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.41Coding Scenario #4 Access is gained at both the right common femoral and leftcommon femoral arteries. Catheter is placed into the aortafor an aortogram with runoff. A stenosis bridging the commoniliac arteries and the aorta is noted. Kissing angioplasty andstent placement are performed.– Revascularization codes: 37221‐50– Catheterization codes: Bundled– Diagnostic imaging codes: 75630(59)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.4221
10/20/2021Coding Scenario #5 Access is gained at the left limb of an aorto‐bifemoral bypassgraft. A stent is placed in both the right and left limbs of thebypass graft. Clinical indication is occlusive disease.– Revascularization codes: 37221(RT), 37221(LT)– Catheterization codes: BundledRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.43Lower Extremity Revascularization:Femoral/Popliteal Territory 37224 Revascularization, endovascular, open or percutaneous,femoral/popliteal artery(s) unilateral; with transluminal angioplasty 37225 Revascularization, endovascular, open or percutaneous,femoral/popliteal artery(s) unilateral; with atherectomy, includesangioplasty within the same vessel, when performed 37226 Revascularization, endovascular, open or percutaneous,femoral/popliteal artery(s) unilateral; with transluminal stentplacement(s), includes angioplasty within the same vessel, whenperformed 37227 Revascularization, endovascular, open or percutaneous,femoral/popliteal artery(s) unilateral; with transluminal stentplacement(s) and atherectomy, includes angioplasty within thesame vessel, when performedRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.4422
10/20/2021Lower Extremity Revascularization:Femoral/Popliteal Territory Entire territory is designated as one vessel forcoding purposes:– Common femoral– Superficial femoral– Deep femoral– Popliteal Only 1 code (most extensive procedure) will bereported for interventions in this territoryRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.45Coding Scenario #6 Access is gained at the right common femoral artery andthe catheter is advanced over the aortic bifurcation intothe left common femoral artery for diagnostic imaging.An pseudoaneurysm is noted in the left superficialfemoral artery. A stent is placed to treat thepseudoaneurysm.– Stent codes: 37236– Catheterization codes: 36247– Diagnostic imaging codes: 75710(59)LTRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.4623
10/20/2021Coding Scenario #7 Access is gained at the left common femoral artery and thecatheter is advanced into the right common femoral artery fordiagnostic imaging. Following diagnostic imaging, angioplastyof the popliteal, followed by angioplasty and stent placementin the superficial femoral is performed. Clinical indication isocclusive disease.– Revascularization codes: 37226(RT)– Catheterization codes: Bundled– Diagnostic imaging codes: 75710(59)RTRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.47Coding Scenario #8 Access is gained at the left common femoral artery and thecatheter is advanced to the aortic bifurcation for bilateralrunoff. Following diagnostic imaging, angioplasty and stentplacement in the right superficial femoral artery wereperformed for occlusive disease. Angioplasty is thenperformed of the left superficial femoral artery. Clinicalindication is occlusive disease.– Revascularization codes: 37226(RT), 37224(59)LT– Catheterization codes: Bundled– Diagnostic imaging codes: 75716(59)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.4824
10/20/2021Coding Scenario #9 Access is gained at the right common femoral artery and thecatheter is advanced into the left common femoral forangioplasty of the femoral‐peroneal bypass graft. Followingangioplasty, a stent is placed in the bypass graft. Clinicalindication is occlusive disease.– Revascularization codes: 37226(LT)– Catheterization codes: BundledRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.49Lower Extremity Revascularization:Tibial/Peroneal Territory 37228 Revascularization, endovascular, open or percutaneous,tibial/ peroneal artery, unilateral, initial vessel; with transluminalangioplasty 37229 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, initial vessel; with atherectomy,includes angioplasty within the same vessel, when performed 37230 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, initial vessel; with transluminalstent placement(s), includes angioplasty within the same vessel,when performed 37231 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, initial vessel; with transluminalstent placement(s) and atherectomy, includes angioplasty withinthe same vessel, when performedRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.5025
10/20/2021Lower Extremity Revascularization:Tibial/Peroneal Territory 37232 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, each additional vessel; withtransluminal angioplasty 37233 Revascularization, endovascular, open or percutaneous,tibial/ peroneal artery, unilateral, each additional vessel; withatherectomy, includes angioplasty within the same vessel, whenperformed 37234 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, each additional vessel; withtransluminal stent placement(s), includes angioplasty within thesame vessel, when performed 37235 Revascularization, endovascular, open or percutaneous,tibial/peroneal artery, unilateral, each additional vessel; withtransluminal stent placement(s) and atherectomy, includesangioplasty within the same vessel, when performedRadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.51Lower Extremity Revascularization:Tibial/Peroneal Territory Each artery is considered a separate vessel forcoding purposes– Anterior tibial– Posterior tibial– Peroneal– Tibiperoneal trunk (part of posterior tibial orperoneal)RadRx“Your Prescription for Accurate Coding & Reimbursement”Copyright 2021. RadRx. All rights reserved. Unauthorized distribution is strictly prohibited.5226
10/20/2021Lower Extremity Revascularization:Tibial/Peroneal Territory Up to 3 codes may be reported for this territory– 1 primary– Up to 2 add‐on codes– When revascularization of TP trunk is performed witheither posterior tibial or peroneal revascularization,the TP trunk is considered part of those vessels andshould not be coded separately.– When revascularization is performed in the anteriortibial and TP trunk only, each are considered separatevesselsRadRx“Your Prescription for Accurate Coding
Guide to Mastering Interventional Radiology Coding and creator of Mastering Interventional Radiology & Cardiology Online Education Program. Stacie has 29 years experience in healthcare,
