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Cardiology Coding Alert

Reader Questions:

Report the Cath Placement With Planned Intervention

Published on Sun Sep 19, 2004

Question: My cardiologist performed an atherectomy, a PTA (multiple inflation of the balloon) and placed two stents in the right superficial femoral artery (SFA) via the left femoral artery. He had previously done a bilateral peripheral study to determine the need for the intervention on an earlier date. On the day of the intervention, he also performed angiographic studies of the diseased vessels to pinpoint the exact location. Should I code the cath placement at this session since the intent of the procedure was the intervention?

Florida Subscriber

Answer: Yes, you should report your catheter placement code (36247, Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower-extremity artery branch, within a vascular family) in addition to the planned intervention.
 
If you refer to the introductory text to the peripheral intervention sections of CPT, you will see that "codes for catheter placement and the radiologic supervision and interpretation should be reported, in addition to the code(s) for the therapeutic aspect of the procedure."

 In the case of a planned intervention, you should report the cath placement, the interventional code, and the supervision and interpretation code related to the intervention. You should not report the diagnostic supervision and interpretation code (since the cardiologist did not perform a diagnostic aspect to this study).
 
Also, remember that you should only report sequential interventions in peripheral arteries (for example, angioplasty, atherectomy, and stent placement) if the cardiologist includes certain details in the documentation. Specifically, the cardiologist must document that:
 

  • The intention of the intervention was the less extensive procedure;
     
  • The less extensive procedure failed (based on your carrier's definition of "failed," typically >30 percent residual stenosis); and
     
  • The cardiologist made a decision to move to a higher-intensity intervention after the suboptimal intervention.

    If the documentation does not support these three factors or if your doctor refers to the angioplasty as "predilitation" rather than a primary intervention, you should only report the highest intensity of intervention.
     
    There are, of course, exceptions to many peripheral vascular billing rules. Generally, if the lesion is an ostial renal lesion, insurers will not consider angioplasty a viable primary intervention, so you should not separately report it regardless of what the documentation says. You may want to talk these situations over with your peripheral vascular specialist to make sure everybody is on the same page.

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