EM Coding Alert

Question: Our vascular surgeon performed an inpatient consultation for acute ischemia of the foot and advised the patient that he should undergo angiography with possible intervention. Later that day, the surgeon  performed the angiography and mechanical thrombectomy with fluro of the popliteal artery on the patient. How should I code this?

Colorado Subscriber

Answer: Your surgeon performed a consultation, and if your payer still accepts the consultation codes (99251-99255, Inpatient consultation for a new or established patient, …), you should report it as such. 

Because the surgeon made the decision for surgery during this encounter, you’ll need to attach modifier 57 (Decision for surgery) to the consultation code. 

Remember: Medicare does not recognize the consultation codes and, therefore, for Medicare and other payers that don’t allow 99251-99255, you should report an initial hospital care code (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components ...) with modifier 57 attached. 

Don’t forget: You should also report the angiography with 73725 (Magnetic resonance angiography, lower extremity, with or without contrast material[s]) and the thrombectomy with 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection[s]; initial vessel) based on the documentation of those services. With vascular surgery, there may be other billable codes or different code choices.