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The Vascular Surgery Coding Coach 2011 Archives
| Using Angiogram Code 75774 |
December 29, 2011
Question:
When the catheter is placed in the Common Iliac with S&I performed, advanced to the Common Femoral with S&I performed, and then advanced to the Superficial Femoral Artery with S&I performed, is it appropriate to code the procedure as: 36247, 75710-26, 75774-26, 75774-26-59?
Answer:
CPT code 75774 is an angiogram reported for additional vessels studied after the basic examination. Studying the common iliac, common femoral and superficial femoral arteries are considered part of the basic examination for 75710. 75774 is only reported if an additional, more selective catheterization and imaging study is performed beyond the basic exam. Coding for the above scenarios would be: 36247, 75710-26.
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| New 2011 Bundled Codes for Angioplasty and Stenting |
December 15, 2011
Question:
I understand the angioplasty, stent and atherectomy codes have been bundled. What does that mean?
Answer:
As of January 1, 2011, angioplasty, stent and atherectomy codes, (in the lower extremities only), have been completely changed. Prior to 2011, each of these interventions was reflected in a single stand-alone code. Each code followed component coding rules, which allowed separate reporting of catheterization and radiological supervision and interpretation (S & I). There were also separate codes for open versus percutaneous approaches. Well, no more! CPT has designed a hierarchal system for these codes and the same codes apply whether an open or percutaneous approach is used. Angioplasty is now included in stent and atherectomy. In addition, stent, angioplasty, and atherectomy are all bundled when performed in the same vessel.
As well as bundling the interventions, the new codes also bundle the catheterization and radiology S & I, meaning these are included in the primary codes and are no longer separately billable. Finally, CPT has defined lower extremity arteries into three “vascular territories” and limits the number of interventions that can be reported per territory. There are numerous codes that reflect these new codes. Check the 2011 CPT manual for all the new codes.
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| Atherectomy Coding 2011 - Major Changes! |
December 2, 2011
Question:
What happened to the atherectomy codes in the 2011 CPT book? I can’t find iliac or brachiocephalic atherectomy codes or fem-pop atherectomy. What happened?
Answer:
As part of a complete overhaul of revascularization codes, CPT 2011 made some major changes in atherectomy coding. For lower extremity atherectomies in the femoral-popliteal and tibial/peroneal vascular territories, atherectomy has new codes and is now bundled with angioplasty and/or stent when performed in the same vessel. These new codes apply to both open and percutaneous approaches when performed in these specific vessels. Most significantly, atherectomy codes for all arteries above the inguinal ligament (iliac, brachiocephalic, renal, visceral and abdominal aorta) have been deleted and replaced by Category III codes. These codes are not valued by Medicare and their reimbursement by Medicare and private payers may be problematic. For a complete listing of these codes, go to CPT manual appendix, titled Category III codes.
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| Subclavian Angioplasty With Stent Placement |
November 17, 2011
Question:
Our physician performed a subclavian angioplasty with stent placement due to subclavian stenosis. He had to cut down to the brachial artery to insert the catheter to perform the angioplasty and angiograms. I coded 36120 for the catheter placement, and I am thinking 35458 for the subclavian angioplasty along with the 37207 for the stent placement along with 75960 and 75962. I’m trying to find something in writing to back up my decision to code the angioplasty as well as the stent but unable to do so. Is it Ok to bill both?
Answer:
CPT does not comment on reporting angioplasty and stent in the same vessel, however when the codes were developed it was assumed that both procedures might be needed to treat stenosis in single vessel and each was designed as a stand-alone code. To justify billing both, generally accepted coding principles require that the following be present and documented:
The intent of the intervention was an angioplasty, not an angioplasty and stent combination. If both an angioplasty and stent were documented as the intended interventions, report only the stent. If the surgical plan and operative note document the intention to perform only an angioplasty, but a stent was needed to completely treat the lesion, reporting both the angioplasty and the stent may be justified. Similarly, documentation that merely describes the need for a revascularization procedure, without specifying the exact intervention, might justify reporting both an angioplasty and stent if both were clinically required.
Documentation must specify that there was a therapeutic reason to proceed with a stent following an angioplasty. For example, after the angioplasty was performed, significant residual stenosis was present and a decision was made to insert a stent. In this case, both procedures were performed for a therapeutic reason and both could be justified. Be aware however that payers may differ in their policies regardin the reporting of an angioplasty and stent in the same vessel.
As of January 1, 2011, open and percutaneous lower extremity angioplasty and stent codes have been changed and angioplasty and stent in these vessels are bundled into a single code. At this time upper extremity open and percutaneous angioplasty and stent codes remain individual codes.
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| Fluoroscopic Guidance with Central Catheter Placement |
November 3, 2011
Question:
Our surgeon placed a central line catheter with a port (CPT code 36561). We billed CPT code 77001 for the fluoroscopic guidance. I received an EOB from the payor indicating this was an invalid code. Is this denial reasonable?
Answer:
No, the payor’s denial is incorrect. CPT code 77001*is the correct code assuming the physician documented the use of fluoroscopy, documented a separate interpretation of the procedure and saved radiographic images. Use the instructional guidelines in the CPT manual to construct your appeal. The Guidelines provide the following instructions, “When imaging is used for these procedures, either for gaining access to the venous entry site or for manipulating the catheter into final central position, use 76937, 77001”
* 77001 Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure).
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Find more Questions and Answers in the Vascular Surgery Coding Coach Archives.
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Teri Romano,
RN, MBA, CPC
 Mary LeGrand,
RN, MA, CCS-P, CPC
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