Radiology Coding Alert

Question: The physician performed PTA of a right anterior tibial lesion, PTA of the popliteal artery, and infusion catheter placement in the right anterior tibial artery due to thrombus at the end of the procedure. After 6 hours of Activase infusion (same date), the physician performed a repeat angiogram by placing the catheter in right SFA and then performed repeat PTA of the anterior tibial. The indications for the repeat procedure state, "Thromboembolic phenomenon in the infrapopliteal arteries to PTA of the right popliteal lesion, as well as the totally occluded anterior tibial artery." Which CPT® codes should I report for both services (date of service is 2012)?

Codify Member

Answer: For the first session, consider the following codes, depending on documentation:

• Percutaneous transluminal angioplasty (PTA) of right anterior tibial: 37228 (Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty)
• PTA of the popliteal: 37224 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal angioplasty)
• Infusion catheter placement: 37201 (Transcatheter therapy, infusion for thrombolysis other than coronary); 75896-26 (Transcatheter therapy, infusion, any method [e.g., thrombolysis other than coronary], radiological supervision and interpretation; Professional component).

Note: Reporting an initial revascularization code for each distinct territory treated is allowed. But verify in the documentation that this wasn’t a single lesion treated with a single therapy and therefore reported with a single code. CPT® guidelines state, "When treating multiple territories in the same leg, one primary lower extremity revascularization code is used for each territory treated … If a lesion extends across the margins of one vessel vascular territory into another, but can be opened with a single therapy, this intervention should be reported with a single code despite treating more than one vessel and/or vascular territory."

For the second session, report the follow-up angiography using 75898-26 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion).

Reporting the repeat PTA of the anterior tibial may vary by payer preference, but an appropriate option is to append modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) to 37228.

2013: Starting Jan. 1, 2013, coding for the Activase infusion changes. For same-day arterial thrombolysis infusion and follow-up imaging, report 37211 (Transcatheter therapy, arterial infusion for thrombolysis other than coronary, any method, including radiological supervision and interpretation, initial treatment day). See "37201-37214 Revolutionize Non-Coronary Thrombolysis Coding in 2013" on page 1.