Cardiology Coding Alert

Question: How should I code the following scenario: The cardiologist's starting point was in the right common femoral artery. He placed the catheter in the abdominal aorta for iliofemoral runoff in the left side with results documented. Following this, he placed the catheter in the left popliteal artery and performed an angioplasty with lesion improving to almost 0 percent stenosis. He withdrew the catheter to left SFA. This artery was predilated. He placed a stent in the left SFA.


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Answer: For the stent in the SFA, you should report 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel) and 75960-26 (Transcatheter introduction of intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel).

Rule: With peripheral interventions (excluding carotid and vertebral stenting), you should report the procedural code (from the 30000 series) and the appropriate corresponding imaging code (from the 70000 series).

For the PTA popliteal, you should report 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal) and 75962-26 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation).

You should also report 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) for the cath placement.
 
For the run off on the left side, you should report 75710-26-59 (Angiography, extremity, unilateral, radiological supervision and interpretation; professional component; distinct procedural service). This alerts the carrier that this procedure was a diagnostic study that led to the intervention rather than routine interventional guidance. A National Correct Coding Initiative edit appropriate modifier is necessary to compliantly bypass the NCCI edit effective Jan. 1, 2005.