Watch out for cases requiring 0238T, too. Were you ready to apply CPT's new revascularization codes starting January 1? Check out these six tips to get you on your way. What's changing: Specifically, CPT 2011 adds several new Category I codes that represent lower extremity endovascular revascularization, meaning angioplasty, atherectomy, and stenting. Here's how CPT divides the codes: In this article, iliac artery services are the focus. Look to future articles to discuss femoral, popliteal, and tibial/peroneal services. 1. Watch Procedure and Vessel to Choose Among 37220-+37223 The new Category I iliac service codes are as follows: Reading through the definitions, you see that the codes for iliac services differ based on whether you're coding a service in an initial vessel or in an additional vessel. Your options also differ based on whether you're reporting (1) angioplasty alone or (2) stenting, with angioplasty if performed. (See the Clip and Save on page 5 for a visual representation of how these new codes break down.) On the other hand: 2. Learn How Stent and Angioplasty Affect Coding For most of the codes in the 37220-+37235 range, you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services are included in that code. Warning: Apply the rule: 'When performed': 3. Include RS&I and More in 37220-+37223 One of the major differences between your 2010 and 2011 coding options is that in 2010 you used component coding, but the new Category I codes bundle selective catheterization, radiological supervision and interpretation, and treatment, according to the presentation prepared by AMA CPT Advisory Committee member, Sean P. Roddy, MD, FACS, and AMA Specialty Society Relative Value Scale Update Committee member Gary R. Seabrook, MD, presented at the AMA's CPTand RBRVS 2011 Annual Symposium. Specifically, CPT guidelines explain that -- in addition to the intervention performed -- the Category I codes include: Report separately: Cat. III clue: 4. Tackle Territory Vs. Vessel Vs. Lesion The new codes (37220-+37235) apply to different "territories." Each territory has its own specific set of guidelines. Codes 37220-+37223 fall under the iliac vascular territory. CPT specifies that "the iliac territory is divided into 3 vessels: common iliac, internal iliac, and external iliac." As already discussed, 37220 and 37221 are appropriate for the initial vessel treated. That means they apply to the first iliac artery treated in a single leg. If the physician treats one or two additional iliac vessels in the same leg, then you should choose from +37222 and +37223. Crucial: Be sure you catch that -- because the codes apply per vessel -- you should not report add-on codes for additional lesions in a single vessel. CPT is very clear that "when more than one stent is placed in the same vessel, the code should be reported only once." 5. Check Rule for 1 Intervention in 2-Artery Lesion In some cases, a lesion may extend from one artery into another. If the radiologist can treat that lesion with a single intervention, then you should choose a single code to report that service. CPT offers the example of stenosis that extends from a common iliac into the proximal external iliac. If the physician uses a single stent to treat the lesion, CPT instructs you to report initial vessel code 37221. You should not also report additional vessel code +37223. On the other hand, if the stenotic lesions involve two separate iliac arteries divided by a bifurcation with a break in stenosis requiring multiple therapies, then you should report an "initial" code as well as an "additional" code. 6. Look Out for Work in Both Legs The codes state that they are unilateral, which means they apply to a service on a single side of the body. CPT suggests that if the physician treats the identical territory (such as iliac) in both legs at the same session, you should use modifier 59 (Distinct procedural service) to show both legs are involved. This holds true even when the mode of therapy is different in each leg, such as angioplasty in the left leg and both angioplasty and stent in the right leg. Keep alert for payers' modifier preferences, though, as some may prefer you to use modifier 50 (Bilateral procedure), modifiers RT (Right side) and LT (Left side), or some combination of modifiers for procedures on both legs.
37220-+37223 -- Revascularization, endovascular, open or percutaneous, iliac artery ...