General Surgery Coding Alert

Don’t distinguish new codes by open or percutaneous.

You need to relearn how to code for certain artery and vein angioplasty services before Jan. 1 if you want to get your billing right from day one. But how to streamline your coding isn’t obvious when you first read the new definitions. Here’s a look at the code deletions, additions, and bundled services that will rule your coding for these services next year.

Forget the Old Way for Transluminal Balloon Angioplasty

You won’t find the following codes in CPT^® 2017, because they’re on the deleted list.

Nor will you find the associated supervision and interpretation (S&I) codes for these procedures, because CPT^® 2017 deletes the following codes, too:

• 75962-+75964 for peripheral artery angioplasty S&I
• 75966-75968 for renal or other visceral artery angioplasty S&I
• 75978 for venous angioplasty S&I.

Distinguish New Codes by Vessel Type

To take the place of these deleted codes, CPT^® 2017 adds resequenced codes. Resequenced means you won’t find the codes in the manual in numerical order, but you will find them with similarly defined codes. CPT^® identifies resequenced codes with a symbol: #.

As you get to know the new codes, watch for language in the descriptors clarifying that the codes apply regardless of whether the service is open or percutaneous. And as you may have guessed from the deletion of the S&I codes, these new surgery codes specifically include all imaging and S&I required for the angioplasty. “The new codes continue the CPT^® trend of providing one code to replace a procedure plus an S&I code,” says Ray Cathey, PA, MHS, CMSCS, CHCI, president of Medical Management Dimensions in Stockton, Calif.

Arteries: Note that the first two codes are for arteries. You use the first code for the initial artery and the second for each additional artery:

• 37246 — Transluminal balloon angioplasty (except lower extremity artery[ies] for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
• +37247 — … each additional artery (List separately in addition to code for primary procedure).

Veins: The second set of codes applies to vein services. Again, you have distinct codes for initial and additional veins:

• 37248 — Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpre­tation necessary to perform the angioplasty within the same vein; initial vein
• +37249 — … each additional vein (List separately in addition to code for primary procedure).  

Work Back From List of Exceptions

The codes look straightforward, so they should be fairly easy to adjust to, Cathey says. But be sure to note that the code descriptors list vessel services the codes do not apply to instead of listing the specific vessels the codes do apply to. This construction makes using your Index, being familiar with other code options, and reading guidelines, that much more important.

Note exclusions: You’ll notice that the new artery angioplasty codes exclude “lower extremity artery[ies] for occlusive disease, intracranial, coronary, pulmonary.” You have other codes that apply to these services, such as lower extremity codes 37220-+37239 and coronary codes 92920-92944.

Change dialysis circuit: You should also notice that both the artery and vein new balloon angioplasty code descriptors exclude angioplasty in the “dialysis circuit.” That’s because dialysis arteriovenous shunt coding options will see a change in CPT^® 2017. For coders who report these services, this will be a very important change, says Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions.

On the deleted code list for 2017 you’ll find 36147-36148 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis [graft/fistula]…). In their place you’ll have nine new codes specific to dialysis vascular services to choose from. The new codes allow you to report angiography, balloon angioplasty, stent placement, thrombectomy, thrombolysis, and permanent vascular occlusion performed in a dialysis circuit.