Cardiology Coding Alert

Assuming these codes include catheterization could cost you.

You may have mastered the 2011 Category I updates for revascularization coding, but if you ignore Category III codes, your claims aren't fully compliant.

Codes 0234T-0238T are the key to coding supra-inguinal atherectomy. Here's a breakdown of these codes, what they include, what you may code separately, and when you'll use these codes. The codes in focus are below:

• 0234T, Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
• 0235T, ... visceral artery (except renal), each vessel
• 0236T, ... abdominal aorta
• 0237T, ... brachiocephalic trunk and branches, each vessel
• 0238T, ... iliac artery, each vessel.

Get a Grip on New Codes With Terminology Primer

The AMA created Category I codes (see 37220-+37235) for "PTA, stent, and atherectomy interventions from the aortic bifurcation distally," noted the presentation by AMA CPT® Advisory Committee member, Sean

P. Roddy, MD, FACS, and AMA Specialty Society Relative Value Scale Update Committee member Gary R. Seabrook, MD, at the AMA's CPT® and RBRVS 2011 Annual Symposium. So those codes essentially relate to the lower extremities.

New Category III codes for atherectomy instead apply to the supra-inguinal vessels, the presentation explained.

Supra-inguinal: Supra-inguinal means above (supra-) the inguinal ligaments (which essentially run from the lower, central part of the pelvis to the outer, top of each hip bone). If you look again at the code definitions, you can see the vessels involved.

Atherectomy: Each code descriptor starts with "Transluminal peripheral atherectomy." Transluminal means the physician passes a catheter along the lumen (cavity) of a blood vessel. Peripheral indicates a noncoronary artery. And atherectomy refers to excising plaque from inside the vessel. For example, the physician may use directional, rotational, or laser methods, state guidelines preceding 0234T.

Be cautious when coding atherectomies as some physicians may identify thrombectomies as atherectomies in error. The supplies used for the procedure will assist you in identifying the service.

Approach: The common portion of the code descriptors also specifies "open or percutaneous," so these codes are appropriate for both approaches. The physician may make an open incision. Alternatively, the physician may access the vessel percutaneously, meaning through a small incision in the skin.

Include RS&I, Report Catheterization Separately

The common portion of the 0234T-0238T code descriptors spells out that the codes include radiological supervision and interpretation (RS&I). That means you should not report the following radiology services separately, noted Roddy and Seabrook:

• Roadmapping
• Completion angiography
• RS&I for intervention.

Report cath separately: Although RS&I is included in 0234T-0238T, you may report catheterization separately, Roddy and Seabrook explained.

This instruction to code accessing and selectively catheterizing the vessel differs from the new Category I lower extremity atherectomy codes that include catheterization: 37225 and 37227 (Revascularization ... femoral/popliteal artery[s] ...); 37229, 37231, +37233, and +37235 (Revascularization ... tibial/peroneal artery ...).

Furthermore, unlike those Category I codes, guidelines with 0234T-0238T tell you that these Category III codes do not include the work of "traversing the lesion, embolic protection if used, other intervention used to treat the same or other vessels, or closure of the arteriotomy (by any method)."

Caution: When the physician performs multiple interventions from the same access point during the same encounter, review the guidelines pertaining to all services provided. Experts advise using the guidelines related to the highest valued procedure to help you determine which services you may report separately.

Focus on Iliac Code 0238T

If you take a look at the new Category I revascularization codes (37220-+37235) and the new Category III atherectomy codes (0234T-0238T), you'll see one vascular territory listed in both: iliac. Here's what that overlap means for your coding.

Basic rule: For most of the new codes in the 37220- +37235 range, you should report the one code that represents the service or services performed in a single lower extremity vessel. For example, if the physician both placed a stent and performed an atherectomy in a popliteal artery, you would report only 37227 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal stent placement[s] and atherectomy, includes angioplasty within the same vessel, when performed).

Iliac difference: Iliac coding is an exception to the basic rule. If the physician performs iliac atherectomy in the same vessel as angioplasty or stent placement, it is appropriate to report one code for atherectomy (0238T) and a second code for the angioplasty and/or stent placement, such as 37221 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stentplacement[s], includes angioplasty within the same vessel, when performed).