Cardiology Coding Alert

Question: If a cardiologist performs atherectomy in the posterior tibial and tibioperoneal trunk (same leg), should I separately report the procedures? If so, how should I modify or otherwise identify the artery/branch? Alabama Subscriber  

Answer: You should report peripheral interventions "per vessel." You'll find speculation about what constitutes a vessel (that is, named vessel versus vessels divided by a bifurcation).
 
This is only a concern in those anatomic areas where the vessel name changes when it crosses an anatomic landmark. For example, the external iliac becomes the common femoral where the vessel crosses the femur. The superficial femoral artery becomes the popliteal where it crosses the knee. 

In contrast, the tibioperoneal trunk is a separate vessel by both name and bifurcation (that is, the short vessel begins where the popliteal splits into the anterior tibial and the tibioperoneal trunk). This short vessel then terminates where it bifurcates into the posterior tibial and peroneal arteries. 

Therefore, you should report each intervention separately. You should code the first atherectomy with 35495 (Transluminal peripheral atherectomy, percutaneous; tibioperoneal trunk and branches) and 75992-26 (Transluminal atherectomy, peripheral artery, radiological supervision and interpretation; professional component). Code the second as 35495 and +75993-26 (Transluminal atherectomy, each additional peripheral artery, radiological supervision and interpretation [list separately in addition to code for primary procedure]). Don't forget: You should also report your appropriate catheter placement codes in each vessel: most likely 36247 (Selective catheter placement, arterial system; initial third-order or more selective abdominal, pelvic, or lower-extremity artery branch, within a vascular family) and +36248 (... additional second- order, third-order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family [list in addition to code for initial second- or third-order vessel as appropriate]).