Cardiology Coding Alert

Question: Does IVUS include S&I for the IVUS, or can you report both?

Wisconsin Subscriber

Answer: The answer depends on whether the service was performed on a peripheral or coronary vessel.

Peripheral: Peripheral intravascular ultrasound (IVUS) codes +37250 (Intravascular ultrasound [non-coronary vessel] during diagnostic evaluation and/or therapeutic intervention; initial vessel [List separately in addition to code for primary procedure]) and +37251 (... each additional vessel [List separately in addition to code for primary procedure]) do not include imaging supervision and interpretation (S&I).

So if the cardiologist interprets peripheral IVUS images, you bill S&I separately using 75945 (Intravascular ultrasound [non-coronary vessel], radiological supervision and interpretation; initial vessel) for the initial vessel interpretation with +37250.

And add +75946 (... each additional non-coronary vessel [List separately in addition to code for primary procedure]) to +37251 to report an additional vessel interpretation.

Coronary: If you are coding coronary artery -- rather than peripheral vessel -- IVUS, you should use a single code to report both IVUS catheter placement and imaging supervision and interpretation.

Choose from +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report, initial vessel [List separately in addition to code for primary procedure]) or +92979 (... each additional vessel [List separately in addition to code for primary procedure]).

Key: IVUS codes are add-on codes, so don't try reporting them without the accompanying primary service, or you'll face denials.

Example: You would report 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel) as the initial vessel primary code and then report +37250 as the initial vessel IVUS add-on code.

When performed in a facility setting, note that you should not append modifier 26 (Professional component) to +37250  or +37251. But you should append the modifier to 75945,+75946, +92978, and +92979 because the fee schedule lists both professional and technical components for these codes.

Bonus tip: Many payers consider peripheral IVUS investigational when it's not connected to abdominal aortic aneurysm services, so you may not see separate reimbursement for these codes. But some experts recommend continuing to report the codes for other peripheral areas because it may be useful for statistical purposes and may encourage possible future reimbursement.