# Multiple interventions-peripheral



## KKCODER (Jun 3, 2010)

Scenario 1:
Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:

"Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..."  and;

"TurboHawk LSC device was now advanced and a series of cuts were made in the distal common femoral & the proximal aspect of the right SFA. The Silverhawk was removed after a series of 12 cuts..."

Would you code the atherectomy for both the common fem and superficial fem?


2nd Scenario
Again, stenosis/occlusions documented in each vessel and docum. states:

"Preparations were made for cryoballoon angioplasty of the right SFA and this was performed in 2 locations involving the proximal SFA and the distal aspect of the right common femoral artery with a 6x40 PolarCath device."

Does this support separate angioplasties in both vessels?


Thanks for any input you might have!

Keri


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## Jim Pawloski (Jun 3, 2010)

KKCODER said:


> Scenario 1:
> Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:
> 
> "Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..."  and;
> ...


 To me, it looks like one lesion in each of the reports.  I would only bill for one.
HTH,
Jim Pawloski, CIRCC


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## sbicknell (Jun 3, 2010)

Code each ather done on different vascular sites or separate lesions within the same vascular site. 

_Guideline states "assign one procedure code regardless of the number of studies per operative field or site. However, multiple pathologies (lesions) in the lower extremities (in multiple operative fields) for example, qualify as multiple sites_

1)  Would you code the atherectomy for both the common fem (36246) and superficial fem (36247)?

_So I would code as: common 35493 + 75992-26 with the SFA 35493-59 + 75993-26 and cath placement 36247_

2)  2 locations involving (angioplasty of) the proximal SFA (36247) and the distal aspect of the right common femoral (36246)

_So I would code the Plasty as: proximal SFA 35474 + 75962-26 and cath placement 36247 with rt common femoral 35474-59 + 75964-26_

If he did an ather on the Common Fem, another on the SFA and another on the Popliteal, I would code 36247 for the cath placement and 
35493 + 75992 for the CF
35493-59 + 75993 for the SFA
35495 + 75993-59 for the Pop

It's late at night so correct me if I am wrong


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## dpeoples (Jun 4, 2010)

KKCODER said:


> Scenario 1:
> Dr. reported one atherectomy & I'm trying to decide if 2 are supported. Separate areas of stenosis are documented in each vessel (50% in common fem & 95%+ in SFA) and the report says:
> 
> "Decision was made to proceed with atherectomy of an extremely severe ostial right SFA and distal common femoral stenosis..."  and;
> ...



This looks like a "bridging lesion" to me between the distal CFA and proximal SFA. One lesion (stenotic area), one intervention is the rule I use.
35493/75992 or 35474/75962 and of course 36247 for the catheter placement.

HTH


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## sbicknell (Jun 4, 2010)

correct, if scenario 2 ( proximal SFA and the distal aspect of the right common femoral) is one contineous lesion, then it is coded as one intervention

Hopefully your report documentation iprovides more specifics. If not, then verify with the physician if 1 lesion or 2 separate lesions. He will need to amend his report to support the appropriate coding


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## arleneg527 (Jun 10, 2010)

The CFA and SFA are 1 vessel, I would only code the atherectomy, and cath placement 36247 as it is more intense than the angioplasty.


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## sbicknell (Jun 10, 2010)

CFA and SFA are not 1 vessel for coding purposes.  Under the premise you give, the CFA, SFA, popliteal and peroneal would all be considered one vessel. This would not be correct

The CFA is a 36246 and the SFA is a 36247

If one lesion extending from distal CFA into the SFA (bridging as dpeoples stated), then it is coded as one lesion

If there are 2 separate lesions (is there a space between them, no matter how small?) then code for 2


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