Radiology Coding Alert

Question: How should we code distal embolic protection performed with stenting or angioplasty?

Codify Member

Answer: Before looking for a way to code distal embolic protection (DEP) separately, ensure that it isn't included in the stenting or angioplasty code.

Guideline example: The lower extremity revascularization codes (such as 37220, Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty) include embolic protection based on the CPT® guidelines. That means you should not report DEP separately.

Code example: Certain services have codes that differ based on whether DEP is used, so you should simply choose the code that includes protection. For example, you may need to choose between these two:

• 37215, Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection
• 37216, ... without distal embolic protection.

Policy example: Payers may include the placement in related services. For instance, Part B MAC National Government Services (NGS) posted an article on coronary percutaneous intervention stating "deployment of a device for distal embolic protection during an interventional procedure is considered part of the more complex procedure and is not separately billable." (To locate the article, search by Document ID A50611 at www.cms.gov/medicare-coverage-database/search/advanced-search.aspx, enter the applicable date of service, and click "Search.")

When separate coding is an option: In previous years, experts recommended coding DEP use by reporting unlisted procedure codes 93799 (Unlisted cardiovascular service or procedure) or 37799 (Unlisted procedure, vascular surgery).

In general terms, distal embolic protection refers to placing a device in a vessel during intervention to prevent debris from moving into the rest of the circulatory system.