General Surgery Coding Alert

Don't miss the 'single vessel' exception.

Make sure your surgery practice is ready to implement the overhaul of endovascular revascularization coding.

CPT 2011 adds new codes for lower extremity endovascular revascularization, including angioplasty, atherectomy, and stenting, noted Stacy Gregory, CCC, CPC, RCC, of Gregory Medical Consulting Services, in her presentation, "Peripheral Vascular Coding Tactics," at the 2011 Coding Update and Reimbursement Conference in Orlando (www.codingconferences.com).

Read on to learn the ins and outs of femoral/popliteal codes 37224-37227. Use this information as a companion to "37220, 37221 Overhaul Your Iliac Vascular Intervention Choices" in General Surgery Coding AlertVol. 13,No. A, and an upcoming article covering tibial/peroneal codes 37228-+37235.

Master the Single Code Approach for Fem/Pop Coding

Get familiar with the following new femoral/popliteal service codes, and note that all of the codes include angioplasty in the same vessel when that service is performed:

• Angioplasty: 37224 -- Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
• Atherectomy (and angioplasty): 37225 -- ... with atherectomy, includes angioplasty within the same vessel, when performed
• Stent (and angioplasty): 37226 -- ... with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
• Stent and atherectomy (and angioplasty): 37227 -- ... with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

Remember: The general rule for 37224-37227 is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services are included in that one code.

For example: When your surgeon performs a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report only 37227.That code covers stent placement, atherectomy, and angioplasty. You should not report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227 in this scenario.

Apply This Territory Rule to Avoid Denials

The new peripheral revascularization codes (37220-+37235) apply to different "territories." Each territory has its own specific set of guidelines. Codes 37224-37227 fall under the femoral/popliteal vascular territory.

Key rule: CPT states that "the entire femoral/popliteal territory in 1 lower extremity is considered a single vessel for CPT reporting."

As a result, you should report a single code even if the surgeon performed various interventions for various lesions in the popliteal artery and in the common, deep, and superficial femoral arteries in the same leg at the same session, as noted in the presentation by Sean P. Roddy, MD, FACS, AMA CPT advisory committee member, and Gary R. Seabrook, MD, AMA/specialty society relative value scale update committee member, at the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago.

In these situations, you should use the code for the most complex service.

For example: If the surgeon performs angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should report only atherectomy code 37225.

Don't forget: The codes are unilateral, which means they apply to a service on a single side of the body. CPT indicates that if the physician treats the identical territory (such as femoral/popliteal) in both legs at the same session, you should use modifier 59 (Distinct procedural service) to show both legs are involved.

But watch out for payers' modifier preferences. Some may prefer you to use modifier 50 (Bilateral procedure), modifiers RT (Right side) and LT (Left side), or some combination of modifiers for procedures on both legs.

Check Out the Change From Component Coding

As explained in "2 Handy Tools Make Iliac Intervention Coding a Snap" (General Surgery Coding AlertVol. 13,No. A), CPT guidelines state that -- in addition to the intervention performed -- the codes include:

• Accessing the vessel
• Selectively catheterizing the vessel
• Crossing the lesion
• Radiological supervision and interpretation for the intervention performed
• Any embolic protection used
• Closure of arteriotomy (incision in the artery)
• Imaging performed to document the intervention was completed.

For example: In 2010, you reported a superficial femoral artery angioplasty via antegrade puncture using now deleted code 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal), 36245 (Selective catheter placement, arterial system ...), and 75962 (2010 definition was Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation), Gregory states. In 2011, you should report only 37224 to cover all of the services.

Don't forget: If the physician performs mechanical thrombectomy (such as 37184-+37185, primary, or +37186, secondary), thrombolysis (such as 37201, 75896), or both, to help restore blood flow to the occluded area, CPT states that you may report those services separately.