General Surgery Coding Alert

Question: If the surgeon performs an iliac atherectomy in the same vessel as a stent or an angioplasty, can we report both services?

North Carolina Subscriber

Answer: Yes, based on CPT 2011 codes, you can report a stent (with or without angioplasty) as 37221 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed) in addition to the atherectomy (0238T, Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel).

Reporting both a stent and atherectomy with distinct codes is unique to supra-inguinal arteries. For infra-inguinal vessels, you'll report only the single code that represents the most intensive service.

Here's why: Unlike codes describing atherectomy performed below the inguinal ligaments (such as 37225, Revascularization, endovascular, open or percutaneous, femoral/popliteal artery[s], unilateral; with atherectomy, includes angioplasty within the same vessel, when performed), the Category III codes for supra-inguinal atherectomy don't include "accessing and selectively catheterizing the vessel, traversing the lesion, embolic protection if used, other intervention used to treat the same or other vessels, or closure of the arteriotomy by any method."

Use 37220 for angioplasty without stent: If the surgeon doesn't do the stent, you should use 37220 (... with transluminal angioplasty) instead of 37221 in the example. You can still bill the atherectomy separately using 0238T.