Radiology Coding Alert

Question: I am trying to code for angioplasty of peroneal and tibioperoneal, and angioplasty with stent of the anterior tibial. How would I code this?

Codify Member

Answer: For your case, you should report 37230 (Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement[s], includes angioplasty within the same vessel, when performed) for the angioplasty and stent placement in the anterior tibial.

You should report +37232 (Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty [List separately in addition to code for primary procedure]) once to cover the work in both the peroneal and tibioperoneal

Here's why: CPT® guidelines indicate that the "tibial/peroneal territory is divided into 3 vessels: anterior tibial, posterior tibial, and peroneal arteries."

When you compare the instruction to your case (interventions in the anterior tibial, peroneal, and tibioperoneal), you see the anterior tibial counts as one vessel and the peroneal counts as a separate vessel. CPT® does not count the tibioperoneal as a distinct vessel under this definition of the tibial/peroneal territory.

Apply the rules: You should choose a primary code for the vessel that had the most extensive procedure(s). In this case, you should report 37230 for the angioplasty and stent in the anterior tibial.

Next, consider the guideline that "If other tibial/peroneal vessels are also treated in the same leg, these interventions are reported with the appropriate add-on code." In your case, you should assign +37232 for the angioplasty in the peroneal and include the tibiperoneal service here, as well.

Rationale: If you continue reading the guidelines, you'll learn that you should not code the tibioperoneal work separately. The guidelines state: "The common tibio-peroneal trunk is considered part of the tibial/peroneal territory, but is not considered a separate, fourth segment of vessel in the tibioperoneal family for CPT® reporting of endovascular lower extremity interventions ... For instance, if lesions in the common tibio-peroneal trunk are treated in conjunction with lesions in the posterior tibial artery, a single code would be reported for treatment of this segment."