Radiology Coding Alert

Here's your head start on understanding renal coverage

Don't get left in the dust as CMS rushes ahead to decide PTA and stenting coverage issues. Stay up to date with this look at two recent decisions.

1. Say Sayonara to Increased CAS Coverage

CMS considered expanding coverage for carotid artery stenting (CAS) to patients with 80 percent or greater carotid artery stenosis, even if they had no symptoms. CAS is a successful treatment that is less invasive than traditional methods, says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, a consultant with Deloitte & Touche.

But CMS decided to stick with its current CAS coverage criteria instead of expanding them. Medicare will cover CAS for patients at high risk for carotid endarterectomy and who have 70 percent or more symptomatic stenosis. CMS will also cover CAS for patients in some clinical trials.

Important: The decision memo reaffirmed that CMS covers CAS only when the provider uses an embolic protection device. If device deployment isn't technically possible, Medicare will not cover the procedure.

What this means to you: CMS will continue to cover 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) but won't cover 37216 (... without distal embolic protection). Be sure you have documentation that the provider used an embolic protection device before you report 37215.

Resource: You can see the decision memo online at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=194 "Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting."

2. Keep Eyes Peeled for Renal PTA NCD

You should be hearing more about CMS renal artery PTA and stenting coverage in the coming year. CMS internally generated a national coverage analysis looking into the best treatment for atherosclerotic renal artery stenosis (ARAS).

CMS' goal is to develop a national coverage determination (NCD) for renal artery PTA and stenting.

Medicare now covers renal artery PTA "for patients in whom there is an inadequate response to a thorough medical management of symptoms and for whom surgery is the likely alternative. The PTA for this group of patients is an alternative to surgery, not simply an addition to medical management" (Medicare NCD Manual, 20.7 B1). Renal artery stenting coverage is up to local contractors.

Watch out: The Society of Interventional Radiology (SIR) expressed its views on renal angioplasty and stenting in a March 28, 2007, letter to CMS, says Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies in Powder Springs, Ga.

The association stated that providers should treat renal artery ostium stenosis with primary renal artery stenting. "Attempts at balloon angioplasty alone," SIR said, "with provisional stenting reserved for those with suboptimal results of balloon angioplasty are not the standard of care and not justifiable."

What this means to you: If the physician intends to place a stent, you should not code artery predilation prior to stenting as an angioplasty. Check your local payer's coding rules, but in general, only report the appropriate stent code, such as 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel ]) .

Resources: You can find the letter on the SIR Web site at www.sirweb.org/codeReim/CMS_RAS_Response_3-28-07.pdf.

Check out the national coverage analysis tracking sheet on the topic online at www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=202 "Percutaneous Transluminal Angioplasty (PTA) and Stenting of the Renal Arteries."