Radiology Coding Alert

Question: I am unable to find any codes for carotid stenting. Can you tell me how to report this procedure?

Massachusetts Subscriber

Answer: Carotid stenting is still considered an investigational procedure and therefore will not be reimbursed by most payers. Codes assigned to this procedure are based on payer guidelines, but it is essential that the coding reflect the investigational nature of the service performed. Some payers require that the CPT codes for transcatheter stent placement (37205, transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel and 37206, each additional vessel [list separately in addition to code for primary procedure]) and imaging supervision and interpretation (75960, transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel) be coded with the carotid artery diagnosis (i.e., 433.10, occlusion and stenosis of carotid artery).Nonetheless, even though coded correctly, it is likely this scenario will result in denial of services.

Other payers may require that unlisted codes such as 37799 (unlisted procedure, vascular surgery) be assigned for the total service (including imaging supervision and interpretation) with a comment in Box 19 of the HCFA 1500 claim form or electronic free-form field stating carotid stent, which will also result in a denial of reimbursement.

As a courtesy, the patient should be made aware that this service will not be reimbursed by insurance, and that payment will be his or her responsibility.