IVUS and Diagnostic-Procedure Codes Can Be Billed Together
Published on Mon Apr 01, 2002
Cardiologists should not assume that reimbursement for intravascular ultrasound (IVUS), whether coronary or peripheral, is simple. Code descriptors were modified in CPT Codes 2000 so the codes could be added to diagnostic as well as therapeutic procedures. However, carriers have yet to revise existing policies and may restrict coronary IVUS to therapeutic procedures only and reject peripheral IVUS altogether.
IVUS is an imaging technique whereby an ultrasound transducer and a rotational mirror are mounted on a catheter tip, which is then inserted directly into the blood vessel. Images of the vessel's internal structure during cardiac catheterization, intervention (such as percutaneous transluminal coronary angioplasty, PTCA), atherectomy or stent placement are then produced.
IVUS is used in coronary and peripheral arteries to provide diagnostic and other information, including location, quantity and type of atherosclerotic plaque. It is also used to facilitate deployment of stents and other therapeutic devices, and assess treatment results.
Coding the Service
IVUS codes include +37250-+37251 (used for peripheral vessels) and +92978-+92979 (used for coronary vessels).
Note that all four codes are add-on codes, which means IVUS is not considered a payable service when performed on its own. It also means that the fee for IVUS should not be reduced as a multiple procedure, because the fees for add-on codes already reflect the fact that the service is performed with a primary procedure.
The codes designating work on additional vessels (+37251 and +92979) should only be reported with the codes designating work on the initial vessel (+37250 and +92978). Use +92979 if IVUS is performed in a vessel in another coronary branch.
Note: If the cardiologist interprets the images obtained during peripheral IVUS, 75945 (Intravascular ultrasound [non-coronary vessel], radiological supervision and interpretation; initial vessel) and +75946 ( each additional non-coronary vessel [list separately in addition to code for primary procedure]) may be billed with +37250 and +37251.
For example, if a stent is placed in the left anterior descending artery, a PTCA is performed in the left circumflex artery, and IVUS is performed in both coronary vessels, the session would be billed as follows:
92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel)
+92984 (Percutaneous transluminal coronary balloon angioplasty; each additional vessel [List separately in addition to code for primary procedure])
+92978
+92979
Note: Code +92984 is correctly used when a second PTCA is performed on a second coronary vessel. Two "initial" interventions (for example, 92980 and 92982) cannot be billed [...]
