Tuesday, December 3, 2019

Endovascular Revascularization

This edition of “Spotlight on CPT” examines endovascular revascularization of the lower extremities.  These procedures are performed when patients have occlusive peripheral vascular disease.  All the codes in this section (37220-37235) apply regardless of whether the procedure is performed via an open or transcatheter percutaneous approach.  Every code in this section includes balloon angioplasty if it is performed.

This series of codes has several inclusive components:

  • Access and/or selective catheterization of vessel
  • Radiological supervision and interpretation related to intervention
  • Embolic protection
  • Arteriotomy closure by pressure 
  • Application of closure device 
  • Imaging which documents the intervention and completion of the procedure

The procedures that are included in these revascularizations are transluminal angioplasty, atherectomy, and stent placements.  Three arterial vascular territories are addressed with these codes: iliac, femoral/popliteal, and tibial/peroneal. 

  • Iliac vessels-common iliac, internal iliac, and external iliac
  • Fem/Pop vessels-this territory is considered one vessel for these procedures
  • Tibial/Peroneal vessels-anterior tibial, posterior tibial, and peroneal (the common tibio-peroneal trunk is part of this territory, but not considered a separate vessel)

Each of these vascular territories have specific coding guidelines.  For example, in the fem/pop territory there are no add-on codes, only the most extensive procedure is coded.  More specifics can be found in the notes that precede this series of codes. 

These revascularization procedures are built on a hierarchy.  Coding professionals should assign a code for the most intensive services provided per vessel treated.  Add-on codes are used to assign codes for additional vessels within a territory, not when distinct lesions are treated in the same vessel.  Multiple stent insertions in the same vessel are only reported once.  When an occlusion traverses two vessels, for example the common iliac and into the internal iliac, and is treated with one intervention (stent) across both vessels, only one procedure is coded.  This would be coded to 37221 and no additional code would be assigned.  However, if there are bifurcation lesions requiring intervention in distinct branches of the iliac or tibial/peroneal territories, then two codes would be assigned. 

If procedures such as mechanical thrombectomy or thrombolysis are performed to address the occlusion, they should be separately reported. 

Now, light has been shed on coding endovascular revascularizations.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.