Radiology Coding Alert

Look for new codes and learn what additional services you can report.

You need to update your knowledge for reporting intravascular stenting if your radiologist does this procedure for the carotid or innominate arteries. CPT® 2014 revises the available codes for these procedures. Read on to get the scoop so you’ll be ready to implement the code changes effective Jan. 1, 2014.

Replace Transcatheter Stent Placement Codes

You’ll no longer use the following five codes beginning the first of next year, because CPT® 2014 deletes them:

• 37205 — Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel
  
• +37206 — … each additional vessel (List separately in addition to code for primary procedure)
  
• 37207 — Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac and lower extremity arteries), open; initial vessel
  
• +37208 — …each additional vessel (List separately in addition to code for primary procedure)
  
• 75960 — Transcatheter introduction of intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity artery), percutaneous and/or open, radiological supervision and interpretation, each vessel.
  

“These deletions are based on the finding of the Relativity Assessment Workgroup (RAW) which identified these code pairs as being reported together more than 75% of the time. Therefore, these codes were deleted and replaced by more inclusive codes,” says Christy Hembree, CPC, Team Leader, Summit Radiology Services, Cartersville, GA. “The old codes were separated by open vs. percutaneous but were nonspecific in that they could be used for both the arterial and venous system.”

In their place, you’ll find the following four new codes:

• 37236 — Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery
  
• +37237 — …each additional artery (List separately in addition to code for primary procedure) (Use with 37236)
• 37238 — Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein
  
• +37239 — … each additional vein (List separately in addition to code for primary procedure) (Use with 37238).
  

Radiological supervision is inclusive: If you were thinking you could bill separately for the radiological supervision, think again. The code 75960 for the radiological supervision and interpretation (S&I) is no longer valid. “The new codes include radiological supervision and interpretation that is directly related to the intervention(s) performed and all angioplasty within the same vessel,” says Hembree. “The deletion of 75960 will eliminate certain aspects of component coding by consolidating most aspects of stent coding into a single code. This consolidation is helpful from a coding aspect and should reduce confusion amongst coders. However, this may lead to lower reimbursement.”

Fee alert: Check for the payment you get. Such codes can be more straightforward to use and understand, but they often result in decreased reimbursement.

Other distinctions: Bundling S&I isn’t the only difference between the old and new codes. The structure of the new codes differs from what you’re used to for 37205-37208. Here is what is new for you when you’ll use the new codes beginning Jan. 1.

1) You have common codes for percutaneous and open access: Codes 37236, +37237, 37238, +37239 apply to both percutaneous and open access for transcatheter placement of an intravascular stent(s). When selecting from these new codes you need not focus on the open or percutaneous approach. “Approach is no longer a factor in code choice as these new codes include both an open and percutaneous approach,” says Hembree. “This will make coding a lot more straightforward.”
2) You need to specify the vessel: Codes 37236 and +37237 are for intravascular stenting in arteries. For venous stenting, you report codes 37238 and +37239. “The new codes are now separated depending on if the stent is placed in the arterial or venous system,” says Hembree. “With the new stent codes specifying which vascular system they should be reported with, arterial or venous, coders should feel more comfortable in their code choice. Coding becomes easier when the code specifically spells out the service you are reporting.”
3) Watch for arteries for which the codes don’t apply: Codes 37236 and +37237 exclude lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary arteries. Now you have to exclude extracranial vertebral and intracranial arteries too. The 2013 codes only excluded the coronary, carotid, vertebral, iliac, and lower extremity arteries. “It is important to note that the new stent codes are not replacing all stent codes and should not be used where other more specific codes currently exist like lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary,” says Hembree. “The more detailed exclusion notes give greater clarification to when it is appropriate to use CPT® 37236 and + 37237.”
4) Do not report for moderate sedation separately: Unlike the earlier codes, the new codes 37236, +37237, 37238, +37239 are inclusive of moderate sedation.

The new codes include services such as angioplasty which are inclusive of moderate sedation,” says Hembree.

Get the Most from the Guidelines

Many of the stent placement rules you’re already familiar with apply to new codes 37236-+37239. Specifically, a single code represents one or more stents placed in a single vessel. Also, if one intervention can treat a single lesion that extends from one vessel to another, use only a single code.

Do not miss these services: “You can report for ultrasound vascular access when performed in conjunction with 37236-37239. Also note that intravascular ultrasound may be reported separately,” says Hembree. Although these codes incorporate multiple services, don’t miss the codes you may report separately:

• Vascular access ultrasound guidance is separately reportable using +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting [List separately in addition to code for primary procedure])
• Intravascular ultrasound also may be reported separately (+37250, +37251, Intravascular ultrasound [non-coronary vessel] during diagnostic evaluation and/or therapeutic intervention…).
• Other separately reportable services include mechanical thrombectomy (37184-37188) and thrombolytic therapy (37211-37214).

Greet Retrograde Stent Placement

CPT® 2014 introduces a new code to report transcatheter stent placement in either the intrathoracic common carotid artery or innominate artery using an open cervical carotid approach. A major feature of this code is that it is specific to retrograde treatment, which means going against the flow of blood in the vessel. Any angioplasty or radiological guidance required for the service is also included.

The new code is 37217 (Transcatheter placement of an intravascular stent[s], intrathoracic common carotid artery or innominate artery by retrograde treatment, via open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation). “This CPT® code is used to report transcatheter stent placement in either the intrathoracic common carotid artery or innominate artery,” says Hembree.

Watch for some key terms when you report code 37217. “CPT® 37217 should only be reported for retrograde treatment (going against the flow), via an open approach (cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure) and on the ipsilateral side (located on or affecting the same side of the body) of cervical carotid artery exposure,” says Hembree.

Be sure to keep the following codes off of your 37217 claim when performed on the same side of the body:

• 35201 — Repair blood vessel, direct; neck
• 35458 — Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel
• 36221 — Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed
• 36222-36227 — Selective catheter placement …
• 75962 — Transluminal balloon angioplasty, peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation.

Note: In 2014, you no longer report the following embolization codes:

• 37204 — Transcatheter occlusion or embolization (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck
• 37210 — Uterine fibroid embolization (UFE, embolization of the uterine arteries to treat uterine fibroids, leiomyomata), percutaneous approach inclusive of vascular access, vessel selection, embolization, and all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the procedure.