Billing Carotid Stent Without Embolic Protection

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Question:

During angioplasty and stent placement of the carotid artery, I was unable to deploy the embolic protection device even though it was my intent to do so. Can I bill 37215, carotid stent with embolic protection with a 52 modifier? Medicare will not pay for the carotid stent code without embolic protection.

Answer:

You are correct. Medicare national coverage policy does not cover carotid stent without embolic protection, CPT code 37216. However, if you are unable to deploy the protection device, regardless of the reason, you must report 37216. 37215 with a 52 modifier would not be appropriate.