Question:
How should we code distal embolic protection performed with stenting or angioplasty?Codify Member
Answer:
Before looking for a way to code distal embolic protection, ensure that it isn't included in the code for the stenting or angioplasty.
Guideline example:
The lower extremity revascularization codes (such as 37220,
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty) include embolic protection based on the CPT® guidelines. That means you should not report distal embolic protection separately.
Code example:
Certain codes also differ based on whether distal embolic protection is used, so you should simply choose the code that includes protection. For example, you may need to choose between:
- 37215, Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection
- 37216, ... without distal embolic protection.
Policy example:
Payers may include the placement in related services. For example, Part B MAC National Government Services (NGS) posted an article on coronary percutaneous intervention stating "deployment of a device for distal embolic protection during an interventional procedure is considered part of the more complex procedure and is not separately billable." (Search A50611 at
www.cms.gov/medicare-coverage-database/search/advanced-search.aspx.)
When separate coding is an option:
In previous years, experts recommended coding the use of distal embolic protection by reporting unlisted procedure codes 93799 (
Unlisted cardiovascular service or procedure) or 37799 (
Unlisted procedure, vascular surgery).
In general terms, distal embolic protection refers to placing a device in a vessel during intervention to prevent debris from moving into the rest of the circulatory system.