Radiology Coding Alert

Question: How should I code external iliac and common femoral angioplasty stent procedures? Would it be only 37221? Or may I also code 37226?

Codify Member

Answer: If the physician performed separate therapies for the iliac and femoral arteries, you should report both 37221 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement[s], includes angioplasty within the same vessel, when performed) and 37226 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal stent placement[s], includes angioplasty within the same vessel, when performed).

Support: The iliac and femoral arteries are considered to be separate territories for these revascularization codes, so you may report the service separately. Coding guidelines state, "When multiple vessels in multiple territories in a single leg are treated at the same setting, the primary code for the treatment in the initial vessel in each vascular territory is reported."

Caution: In some cases, a lesion may cross from one territory to another, and the physician will need to deploy only one stent to treat that lesion. In that case, "this intervention should be reported with a single code despite treating more than one vessel and/or vascular territory," the guidelines state.

When choosing your code, keep in mind that the relative value units (RVUs) for 37226 are higher than those for 37221, particularly in a non-facility setting. Medicare's national non-facility price for 37221 is $4,686.36, compared to $9,004.09 for 37226.