Part B Insider (Multispecialty) Coding Alert

Transcatheter stent placement codes clarify coding muddle

Once again, the wheels of coding turn slower than the gears of technological change - but coders finally have a vehicle that works.

Coders have been struggling for years with billing for endovenous ablation, a minimally invasive technique for treating varicose veins. Usually, the physician inserts a catheter using ultrasound imaging and guides an ablation probe into the great saphenous vein, then heats it or seals it using ultrasound, radiofrequency or laser energy.

Old way: There weren't any particular codes for this technique, and payors were stuck between unlisted code 37799 and a couple of other codes that approximated the work (see PBI, Vol. 5, no. 9, p. 63).

New way: Now at last coders have a set of codes specifically designed for endovenous ablation, according to preliminary code lists obtained by PBI. CPT codes 36475-36476 will cover the treatment via radiofrequency, for the first vein and subsequent veins treated respectively. Similarly, 36478-36479 will cover endovenous ablation via laser for the first and each additional vein respectively.

A specific set of codes will be a welcome alternative to the old confusion, says Carolyn Artis, a coder with Eastern Radiology in Greenville, NC. She's been stuck trying to bill either an unlisted code or obscure code S2130 for the procedures.

The new codes also include 32019 (Insertion of indwelling tunneled pleural catheter with cuff), 34803 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [two docking limbs]) and 36818 (Arteriovenous anastomosis, open; by upper arm cephalic vein transposition).

Separately, new codes are coming for transcatheter placement of intravenous stents in the cervical carotid artery (37215-37216). These compliment two Category III codes introduced in July for transcatheter placement of extracranial vertebral or intrathroacic carotid artery stent(s), (0075T-0076T).

The two new Category I codes cover stent placement with or without distal embolic protection respectively, and they're intended to complement the two new Category III codes, according to Dawn Hopkins, coding expert with the Society for Inter- ventional Radiology. The Category I codes are more specific as to the location of the catheter in the cervical carotid artery, she says.