Cardiology Coding Alert

Support: AMA's CPT Assistant (August 2006) states that "Since the inception of component coding for interventional radiology procedures, the femoral and popliteal arteries have been considered two distinct vessels. If there are distinct lesions found in both the femoral and popliteal arteries and each lesion is treated separately with Transluminal balloon angioplasty, CPT code 35474 would be reported twice."

You should append modifier 59 (Distinct procedural service) to the second code.

Catch this: According to CPT Assistant (December 2007), if one contiguous lesion bridges more than one vessel, this is one angioplasty service. You should "code for the vessel that is dominantly involved and treated." (Bonus tip: That same article explains that if the physician treats multiple lesions in a single artery, you should report only one angioplasty service for that artery.)

RS&I: Don't forget to report the related radiological supervision and interpretation code(s): 75962-26 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation; Professional component) for the first vessel and +75964-26 (Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation [List separately in addition to code for primary procedure]) for the second.

If you use the same vascular access point site for both interventions (which is typical), you should report the appropriate selective catheterization code only once. For example, if the doctor accessed the right common femoral artery and advanced the interventional catheter into the contralateral (left) superficial femoral and popliteal arteries, you would report code 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family).