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Cardiology Coding Alert

Reader Question:

You'll Need Both Codes for Femoral/Popliteal Work

Published on Mon Mar 22, 2004

Question: What advice can you offer for a Medicare hearing appeal for two angioplasties in the femoral and popliteal arteries? We coded the second 35474 with modifier -59. But I am concerned that Medicare is going to look at 35474 and say that the code represents both the femoral and popliteal arteries, so it should be coded only once.

New York Subscriber
 
Answer: You should code interventions in the peripheral artery system "per vessel."  For coding purposes, the femoral artery and the popliteal artery are distinct vessels.  Therefore, when the physician performs interventions in each of these vessels, you should bill for each separately.

In this case, you should bill 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal) for the first procedure with 75962 for the radiological supervision and interpretation.

You should report 35474 and append modifier -59 (Distinct procedural service) to indicate that the second angioplasty is distinct. Report 75964 for the radiological supervision and interpretation for the second procedure. Append modifier -26 (Professional component) to 75964 if the physician performs the procedure in a facility setting.

You should also bill the appropriate cath placement code, in addition to the intervention. Depending on the access site, you would report 36246 (Selective catheter placement, arterial system; initial second-order abdominal, pelvic, or lower extremity artery branch, within a vascular family) or 36247 (... initial third-order or more selective ... lower extremity artery branch).

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