General Surgery Coding Alert

Question: Our surgeon performed an atherectomy and PTA in the PT, AT, and peroneal arteries, accessed with atherectomy through the tibial/peroneal trunk. How should we code this?

California Subscriber

Answer: The correct coding for this scenario is 37229 (Revascularization, endovascular, open or percutaneous, tibial/ peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed), and two units of +37233 (Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed [List separately in addition to code for primary procedure]).

Here's why: You should not code angioplasty (percutaneous transluminal angioplasty, PTA) separate from the atherectomy. That's because you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services in that vessel are included in that one code, so the angioplasty is bundled into the atherectomy.

Watch the territory: CPT® guidelines state that "the common tibial-peroneal [TP] trunk is considered part of the tibial/peroneal territory, but is not considered a separate, fourth segment of vessel in the tibio-peroneal family for CPT® reporting of endovascular lower extremity interventions." That means you should bundle the TP trunk into the code for the initial vessel. You'll code the initial vessel (posterior tibial, PT, atherectomy) using 37229. Additionally, you'll report two units of +37223 for each additional vessel -- anterior tibial (AT) and peroneal.