Cardiology Coding Alert

Know which included services you cannot separately report.

In the session “A Look at Peripheral Vascular/Interventional Surgery” during HEALTHCON 2022, speaker Caren Lampitoc, CPC, COC, CPMA, CRC, CPCD, CPB, shared helpful information you can apply to understand how to successfully code revascularization cases in your practice. For example, you must know which artery your cardiologist worked in, as well as what type of procedure they performed, and the specific hierarchy.

Take a look at the expert advice below to ensure you submit clean revascularization claims.

Discover Different Types of Arteries

When you look at the first area, or territory as it’s described in CPT®, you see the iliac artery, Lampitoc said. Within this system, you have three opportunities to code. The first is the common iliac, which you should code by vessel, not lesion. The second is the internal iliac, and you can code each vessel with add-on codes. The third is the external iliac, and up to two add-on codes can be used per side.

With these code sets, you have a primary code, then you have up to two additional add-on codes that can be applied, Lampitoc added.

“This area of understanding with regards to these territories and your opportunity to have additional coding opportunities is so important,” Lampitoc said. “When I have audited this type of surgery before, this is one of the areas, not just in the iliac territory, but in the other territories, where codes are left on the table because the coder didn’t account for the fact that you have different areas within a given territory to be able to additionally code, depending on the procedures that are done.”

Don’t forget that the femoral/popliteal area is considered one, single territory despite the fact that there are both femoral and popliteal arteries, Lampitoc explained.

Then, within the tibial/peroneal arteries, you have three territories, according to Lampitoc. These include the anterior, posterior, and peroneal.

Check Out Hierarchy by Vessel and Procedure

Lampitoc shared the following chart to help you see which codes to report for each type of procedure, whether angioplasty, stent, or atherectomy:

When you look at the different procedures in this code set such as angioplasty, stent, and atherectomy, you can see that they are built on a higher hierarchy of codes, Lampitoc explained. Angioplasty is always bundled into stent and/or atherectomy. For example, if angioplasty is done, it does not work, and the cardiologist has to recoil and move on to stenting, the angioplasty is included in the stenting, and you should not additionally code for it.

Looking from left to the right at the chart above, you can see the code sets and when you have the opportunity to bill for add-on codes for an additional ipsilateral, Lampitoc said.

Knowing terms such as “ipsilateral” versus “contralateral” is very important as a coder, according to Lampitoc. Ipsilateral means on the same side, such as everything on the left. On the other hand, contralateral means going to the opposite side.

Then, on the chart, you move on through the territories across from left to right from iliac/ popliteal to the lower leg tibial/peroneal and again with the add-on codes. Same thing with stenting, Lampitoc said. When you move into atherectomy, you have Category III codes for the iliac area because you don’t have a true CPT® code in those sections yet to report for the iliac territory when your cardiologist performs atherectomy in those vessels.

Understanding the structure and hierarchy is vital when looking at notes and what you can code and how to account for those additional vessels within a given territory or moving from one territory to another, Lampitoc added.

Heed Included Services

Remember that some work is included in the revascularization codes, so you cannot report those services separately, Lampitoc says. The following work is included:

• Accessing and selectively catheterizing the vessel
• Traversing a lesion
• Radiological supervision interpretation directly related to the intervention
• Embolic protection, if used
• Closure of the arteriotomy by pressure and application or by some sort of closure device or standard closure by suture
• Imaging performed to document completion of intervention in addition to the intervention performed

Ask Handy Questions for Proper Code Selection

Lampitoc shared the following questions to ask yourself when you have an operative report in front of you and are deciding between the different codes for revascularization:

1. What vessel is the cardiologist in?
2. What territory is the cardiologist in?
3. What territories did they get to?
4. How many interventions did the cardiologist do in each territory? Is there a hierarchy or hierarchical building of these different code sets, and how can I code for them?
5. What was the most extensive procedure?
6. Did the lesion extend across two territories, and how were the lesions treated?

Once you have the answers to these questions, you’ll be able to navigate to the correct codes to report.