Radiology Coding Alert

Question: If the radiologist documents "peripheral angioplasty with cryoplasty balloon of critical stenosis in the distal left SFA and left popliteal artery," which CPT codes should I report for a hospital procedure? He accessed the vessel from the right femoral artery.

Georgia Subscriber

Answer: For the superficial femoral artery (SFA) intervention, you can report 35474 (Transluminal balloon angioplasty, percutaneous; femoral-popliteal) and 75962-26 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation; Professional component).

Note the modifier 26 on the RS&I code to indicate you're reporting only the professional service.

Assuming that these two interventions address separate lesions (rather than one lesion that overlaps the two vessels), you also would need to code for the popliteal PTA with 35474-59 (... Distinct procedural service) and +75964-26 (Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation [List separately in addition to code for primary procedure]).

How to count lesions: AMA's CPT Assistant (August 2006) states that "since the inception of component coding for interventional radiology procedures, the femoral and popliteal arteries have been considered two distinct vessels. If there are distinct lesions found in both the femoral and popliteal arteries and each lesion is treated separately with Transluminal balloon angioplasty, CPT code 35474 would be reported twice."

You should append modifier 59 to the second code.

But according to CPT Assistant (December 2007), if one contiguous lesion bridges more than one vessel, this is a single angioplasty service. You should "code for the vessel that is dominantly involved and treated." (Bonus tip: That same article explains that if the physician treats multiple lesions in a single artery, you should report only one angioplasty service for that artery.)

Watch for: The contralateral popliteal cath placement is 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family). Therefore, you should not separately report any lesser-order cath placement codes (36140, 36200, 36245, and 36246) for this intervention.

Key: The cryoplasty balloon use doesn't change your code assignment. Your coding is the same for cryoplasty, cutting balloon, and regular angioplasty.

-- The answers for You Be the Coder and Reader Questions were reviewed by radiology coding expert Jackie Miller, RHIA, CCS-P, CPC, vice president of product development for Coding Metrix in Powder Springs, Ga