Cardiology Coding Alert

Question: Our physician performed a cutting balloon angioplasty on the left subclavian artery, the left brachial artery and the left axillary arteries for severe in-stent restenosis. During the procedure, he performed a diagnostic angiography of all three vessels. He advanced the catheter first to the subclavian artery, then to the brachial and axillary arteries and performed injections of each before the cutting-balloon intervention. How should I code this?

New Hampshire Subscriber

Answer: Although cardiologists typically use cutting balloons to correct restenosis in coronary arteries, they may reasonably use this procedure to correct restenosis in the peripheral arteries as well.

No CPT code specifically describes a percutaneous transluminal angioplasty (PTA) of these left-side major vessels (they are not part of the brachiocephalic trunk, which is right-side only), so you must use 37799 (Unlisted procedure, vascular surgery) for each of the three vessels.

Therefore, report 37799 for the PTA of the left subclavian artery and 75962 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation) for the supervision and interpretation (S&I) of the left subclavian PTA. Report 37799 for the left axillary artery PTA and append modifier -59 (Distinct procedural service) to indicate that the physician performed the intervention (37799) on three separate vessels. For the S&I of the left axillary artery PTA, report +75964 (Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation [list separately in addition to code for primary procedure]). For the PTA of the left brachial artery, report 37799 and append modifier-59. Use 75964 for the S/I of the left brachial PTA.

For the selective catheter placement in the left brachial artery, report 36217 ( initial third order or more selective thoracic or brachiocephalic branch, within a vascular family). The catheter's endpoint in this family is the brachial artery, so 36217 includes stopping in the subclavian and the axillary.

To report the radiological S&I, use 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) for the angiogram in the subclavian artery.

You would report add-on code +75774 (Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation [list separately in addition to code for primary procedure]) for the axillary artery angiogram. You would also report 75774 for the brachial artery angiogram and append modifier -59.