# angioplasty for a carotid artery? - here it is. for some reason



## rykin7609 (Jun 20, 2012)

Okay, here it is. for some reason I have it in my head that there must be a CPT code for and Angioplasty for a Carotid Artery. 

Does anyone know what this code is, if it even exists? Or am I just thinking about this too hard?


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## Jim Pawloski (Jun 20, 2012)

rykin7600 said:


> Okay, here it is. for some reason I have it in my head that there must be a CPT code for and Angioplasty for a Carotid Artery.
> 
> Does anyone know what this code is, if it even exists? Or am I just thinking about this too hard?



I would use 35475 and 75962 - brachiocephalic artery.  But don't use this if a carotid stent is placed, because the PTA is bundled into the procedure.

HTH,
Jim Pawloski, CIRCC


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## lcterry (Jun 21, 2012)

I thought Carotid PTA was covered in some instances.  Am I reading this wrong? or did they rescind the rule and I didn't get the memo. 




http://www.cms.gov/medicare-coverag...id+Artery+Stenting&IsPopup=y&bc=AAAAAAAABAAA&


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## jtuominen (Jun 21, 2012)

First of all, make sure you identify what you are trying to treat. If your provider is trying to dilate a carotid artery stricture, maybe to deliver a coil embolization to another vessel intracranially, and can't advance his catheter without dilating this more proximal stricture,you should not bill for a PTA. PTA can only be billed when treating athersclerotic disease. You may want to consider billing 37799 for dilating a stricture of a vessel (the Dotter technique) although I don't think Ive ever read a report where this was done to a carotid artery, they usually do this in the legs.

35475/75962 should be used for PTAs of the brachiocephalic artery and its branches outside of the head. If you are treating an intracranial area (like the intracranial carotid artery) use 61630 for PTA of athersclerotic disease. RS&I, cath placement, and diagnostic imaging is all included in that code. If you are treating intracranial vasospasm, check out 61640 - 61642.

PTA of a carotid or vertebral artery without stent placement is considered a noncovered service by CMS at this time. It is covered only when furnished in accordance with the FDA-approved protocols governing Category B IDE clinical trials (NCD 20.7). So you might have a tricky time getting this paid if the only service rendered to the diseased area was a PTA.

Jayna


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## Jim Pawloski (Jun 21, 2012)

jtuominen said:


> First of all, make sure you identify what you are trying to treat. If your provider is trying to dilate a carotid artery stricture, maybe to deliver a coil embolization to another vessel intracranially, and can't advance his catheter without dilating this more proximal stricture,you should not bill for a PTA. PTA can only be billed when treating athersclerotic disease. You may want to consider billing 37799 for dilating a stricture of a vessel (the Dotter technique) although I don't think Ive ever read a report where this was done to a carotid artery, they usually do this in the legs.
> 
> 35475/75962 should be used for PTAs of the brachiocephalic artery and its branches outside of the head. If you are treating an intracranial area (like the intracranial carotid artery) use 61630 for PTA of athersclerotic disease. RS&I, cath placement, and diagnostic imaging is all included in that code. If you are treating intracranial vasospasm, check out 61640 - 61642.
> 
> ...



Jayna,
Thanks for the update on the CMS part of the angioplasty.  Did you see if Angioplasty is covered during an attempt to place a stent, but due to atherosclerosis, the stent was not placed.  Or do you still bill for the stent, but add a reduced charge modifier to it.
Thanks,
Jim Pawloski, CIRCC


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## jtuominen (Jun 21, 2012)

I havent seen anything from CMS on that failed attempt scenario.
But what I would do is examine intial intent first--If the intial intent is to place a stent, and it is discontinued or cancelled due to well being of the patient, and curtailed with a PTA of the athersclerotic region instead, Id probably bill the stent code with cancelled procedure modifier (ie 61635-74 or 61635-53). Since the rules in the CPT book do state that when PTA is followed by stent placement that the PTA is included within the stent charge (check out definition of 61635), Id say you've covered your costs and accurately described the events of the situation of a failed stenting attempt by billing the stent code with a modifier.


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## Jim Pawloski (Jun 21, 2012)

jtuominen said:


> I havent seen anything from CMS on that failed attempt scenario.
> But what I would do is examine intial intent first--If the intial intent is to place a stent, and it is discontinued or cancelled due to well being of the patient, and curtailed with a PTA of the athersclerotic region instead, Id probably bill the stent code with cancelled procedure modifier (ie 61635-74 or 61635-53). Since the rules in the CPT book do state that when PTA is followed by stent placement that the PTA is included within the stent charge (check out definition of 61635), Id say you've covered your costs and accurately described the events of the situation of a failed stenting attempt by billing the stent code with a modifier.



thanks for the info.
Jim


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## rykin7609 (Jun 21, 2012)

Thanks for the information. 

My scenario is a stent was placed in the left *EXTERNAL* carotid, the angioplasty was performed for stenosis is the left *INTERNAL* artery. 

So in this case is the stent the driving code?, well I would assume it is however does this mean the angioplasty is bundled into this....even though it was performed in a different artery, but same family?


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## dpeoples (Jun 21, 2012)

rykin7600 said:


> Thanks for the information.
> 
> My scenario is a stent was placed in the left *EXTERNAL* carotid, the angioplasty was performed for stenosis is the left *INTERNAL* artery.
> 
> So in this case is the stent the driving code?, well I would assume it is however does this mean the angioplasty is bundled into this....even though it was performed in a different artery, but same family?





The angioplasty is clearly in a different vessel, and ordinarily could be billed with a 59 modifier. But "ordinary" rules do not apply with regard to carotid artery interventions. 
It is important to note that "Internal Carotid" does not necessarily mean "intracranial" and the physician needs to clearly document the angioplasty was "intracranial" before considering the 61630 code.

If the angioplasty in in the cervical internal carotid (neck) then you would have to use an unlisted code to report that level of service, and if the payor goes by medicare guidelines, you will not be paid since it is a non-covered service. I would hesitate to code for the angioplasty if this were my case.

HTH


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## rykin7609 (Jun 29, 2012)

This does help a lot. Thanks for all the feedback


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