Cardiology Coding Alert

Question: I’ve received denials from Medicare regarding code +37223. When I reached out to them, they provided me with their list of acceptable primary codes to report +37223 with, and 37221 had been deleted. According to their list, codes 34701-+34711, 34718, and 34845-34848 are the only acceptable primary codes to report with +37223. What can I do to get reimbursed for this code? 

Texas Subscriber

Answer: This may just be an oversight, and you should appeal your claims or reach out to the Medical Director of your MAC because the CPT^® section guidelines indicate you can report 37221 as a parent code for +37223.

When the cardiologist treats multiple vessels within a territory, you should report each additional vessel with an add-on code, as applicable, per the CPT^® guidelines. You should select the base code “that represents the most complex service using the following hierarchy of complexity (in descending order of complexity): atherectomy and stent > atherectomy > stent > angioplasty.”

When the cardiologist treats multiple lesions within the same vessel, you should report the one appropriate code that stands for the combined procedures, whether the physician performed the service on one lesion or different lesions, while applying the same hierarchy.

The iliac vascular territory is divided into the following three vessels — the common, internal and external iliacs, according to CPT^®.

You should report one primary code (either 37220 or 37221) for the initial iliac artery the cardiologist treats in each leg, per CPT^®. If the cardiologist treats other iliac vessels in that leg, you should report those procedures with the correct add-on code (either +37222 or +37223).

Caution: You can report up to two add-on codes in a unilateral iliac vascular territory because the cardiologist can treat three vessels. However, you should report the add-on codes just for different vessels, not for “distinct lesions within the same vessel.”

Additionally, in the parenthetical notes, the CPT^® guidelines instruct you to do the following:

• You should report +37223 in conjunction with 37221.
• You can report +37222 and +37223 in conjunction with 34701-+34711, 34718, and 34845-34848 only when the cardiologist performs the +37222 and +37223 services outside the treatment zone of the endograft.