General Surgery Coding Alert

Question: I code for certain dialysis arteriovenous shunt services like angioplasty and stenting. May I report both angioplasty and stenting in the outflow vein if they’re at different places?

Wisconsin Subscriber

Answer: You should include both the angioplasty and stenting in 37238 (Transcatheter placement of an intravascular stent[s], open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein).

CPT^® guidelines state that you report 37238 once to represent all the stenting work within the shunt segment regardless of the number of lesions treated in that vessel segment.

The June 2016 CPT^® Assistant confirms that 37238 includes angioplasty in the same vessel even if it is outside the stented area.

Note that if documentation shows the lesion includes the peri-anastomotic region, CPT^® considers that to be an artery, so you would use 37236 (Transcatheter placement of an intravascular stent[s] [except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary], open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery).