# 37221-lt, 37221-rt?



## calorom2 (Aug 23, 2018)

Would this be 37221-LT and 37221-RT? Thanks in advance for the help!

PROCEDURE: 
Bilateral common iliac stent, bilateral selective angiogram. 

COMPLICATIONS: 
None. 

ESTIMATED BLOOD LOSS: 
Less than 5 mL. 

INDICATION FOR PROCEDURE: 
Lifestyle limiting claudication, recurrent stenting. 

DESCRIPTION OF PROCEDURE: 
After informed consent, discussion of risks and benefits, a 5-French 
sheath was placed in the right common femoral artery under ultrasound 
guidance.  Angiography was performed using a Contra catheter.  The patient 
has had 2 bare metal stents in the right common iliac and there are 
2 areas of stenosis inside the stent of 90% in both in the proximal 
edge and the distal edge.  The patient was anticoagulated to a therapeutic 
ACT.  A 7-French sheath was placed.  The artery was stented with a 8.0 
x 58 atrium covered stent at 12 atmospheres of pressure to reach a size 
of 8.5 with good apposition.  We then took selective angiography of 
the left.  There was a significant lesion in the common femoral, but 
there was no gradient across it.  On pullback, there was a 60 mm gradient 
in the common iliac, selective angiography confirmed 80 to 90% stenosis. 
Of note, right internal iliac is totally occluded and is supplied through 
sacral artery.  The left internal iliac was patent.  We decided to do 
a non-covered stent.  The artery was stented with a cobalt 8.0 x 27 
stent at 10 atmospheres of pressure.  The stent was post dilated proximally 
by a 9.0 __________ x 15.  We did lose the internal iliac on the left. 
I am hoping that 
this collateralizes through that same sacral collateral.  The patient 
was counseled on symptoms.  Further recommendations to follow clinical 
course.


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## Mayzoo (Aug 24, 2018)

I am still fairly new to coding, but this is what I believe; if you are doing the RT & LT vessel it would be 37221, and 37221-59.


37221 Stent placement(s), iliac artery, *unilateral*, initial vessel;

"Bilateral Indicator 0
Bilateral surgery rules do not apply to codes with a status indicator 0. The bilateral indicator is inappropriate for reasons such as:

Physiology; is not a bilateral body part.
The codes description states it is an existing bilateral procedure.
The procedure is not commonly performed as bilateral. (These services do not meet the bilateral criteria.)

These codes should not be billed with modifiers 50, LT or RT."

https://www.emblemhealth.com/Provid...-Modifiers-LT-and-RT-for-Bilateral-Procedures


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