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Cardiology Coding Alert

Peripheral Intervention:

What You Need to Know to Code Correctly

Published on Fri Mar 01, 2002

Coders can toss out the cardiology coding rule book when billing for peripheral intervention (PI), says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. "Coding PI is completely different from what cardiology coders are used to," she says.
 
Relatively few procedures are bundled when PI is performed; therefore, detailing everything the cardiologist did is essential to accurate coding and reimbursement.
 
When the cardiologist places a stent in a coronary artery, for example, only the stent may be billed (in most cases) even if the procedure began as a percutaneous transluminal coronary angioplasty that subsequently required stenting. In this situation, report 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) because any other intervention in the same vessel or vessel family is included in the stent.
 
In peripheral vessels (such as the superficial femoral artery), the stent and its associated supervision and interpretation (S&I) code may be reported separately with the percutaneous transluminal angioplasty (PTA) as long the stent was not planned and the PTA was not performed simply to provide access for the stent. In addition, catheter access codes are payable separately.
 
A superficial femoral PTA that required stenting might be coded as follows (assuming retrograde sheath placement):

 
  • 37205 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; initial vessel

     
  • 35474 Transluminal balloon angioplasty, percutaneous; femoral-popliteal

     
  • 36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

     
  • 75710 Angiography, extremity, unilateral, radiological supervision and interpretation

     
  • 75960 Transcatheter introduction of intravascular stent(s), (non-coronary vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel

     
  • 75962 Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation.
     
    Note: Code 37205 must be reported first, since it is the highest-paid procedure.

    • Reimbursement for PI can be significant because they are billed by the component: While the coronary stent (92980) is assigned 21.84 relative value units (RVUs), the superficial femoral stent and its separately payable components total 36.31 RVUs.
     
    Note: If a diagnostic left heart catheterization (93510) or coronary angiogram (93508) is performed prior to the placement of the coronary stent, it may be reported separately. In such cases, the appropriate injection code (93539-93545) and S&I code (93555-93556) may also be billed. If a diagnostic catheterization has been performed and coronary angiography or left heart catheterization is performed with the stent, it is included in the stent placement.
     
    The same types of interventions are performed in coronary and peripheral arteries: angioplasties, stents and atherectomies. Peripheral PTAs or atherectomies are performed on patients with obstructive atherosclerotic lesions in the lower extremities (iliac, femoral or popliteal arteries) or the upper extremities (the innominate, subclavian, axillary or brachial arteries). Other arteries that may require interventions are the aorta, the renal arteries and head and neck arteries.
     
    Note: Many interventions involving head and neck arteries (for example, the carotid arteries) are investigational and may not be covered.
     
    Carriers regularly adjust the number of arteries for which the placement of a stent is covered. Most will pay for an iliac stent, but coverage policies for other peripheral vessels vary significantly. For instance, some carriers will not cover stent placement in the renal artery.
     
    PTA and atherectomy codes differ from stent placements in that several codes vary by anatomic area. For example, there are separate codes for PTAs in the following vessels: tibioperoneal trunk or branches, renal or visceral arteries, aorta, iliacs, femoral-popliteal, brachiocephalic trunk and branches and the venous system. The same anatomic areas (with the exception of the venous system) have their own atherectomy codes.
     
    There are only two codes for stent placement, one of which is an add-on code. The initial stent placement code (37205) is used to report one or more stents in the initial vessel being treated. If a second vessel in a different vascular family also requires stenting, 37206 ( each additional vessel [list separately in addition to code for primary procedure]) is reported.

    Cross-Linking Radiology Codes

    PI codes are always associated with corresponding radiology codes that should be billed separately.
     
    The codes are often cross-linked in CPT, with the radiology code listed below the surgery code descriptor and vice versa.
     
    Selecting all the codes that may be reported can be intimidating, since the initial catheterization and every intervention performed has an associated radiology S&I code that must be correctly identified, says Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.
     
    It may be helpful to group the codes together in tables, as follows in the above tables:
     
    Note: For stent placement, report 75960 for each vessel.
     
    The radiology codes may also need to be appended with modifier -26 (Professional component), Callaway adds.
     
    "Many coders do not append modifier -26 because the code already says radiologic S&I, which means the same thing as professional component." However redundant it may seem, Callaway notes carriers require modifier -26 when the physician performs radiological S&I.
     
    Note: PI and radiological S&I are often payable in the following places of service: inpatient hospital (place of service code 21), outpatient hospital (22), emergency department (23), and ambulatory surgical center (24).

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