On Demand: Coding for Peripheral Angiography and Intervention-Q&A

Q&A
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A Q&A session on coding for peripheral angiography and intervention was held on 14th December 2023. Here are some of the questions and answers discussed during the session: <br /><br />- To code angiography of the SMA and Celiac if already billing 75716 for legs in the same procedure, code 36245 x 2 for cath placements and 75726 x 2 for visceral angiography.<br />- Humana allows the use of bilateral modifier 50 for code 36200 if bilateral caths are placed.<br />- For angioplasty/stents of lower extremity, code the primary code for the territory and additional interventions as defined in CPT.<br />- If treating both the LT and RT common iliac, code the appropriate intervention code for each side based on the applicable diagnosis.<br />- When accessing the leg from below the knee, code as non-selective placement until crossing the aorta in a retrograde manner. In an antegrade manner, the first vessel encountered past the access site towards the foot becomes first order.<br />- The TP Trunk is considered part of the peroneal and posterior tibial arteries. An additional intervention may be billed if done in the TP trunk and the anterior tibial artery.<br />- There are more specific diagnosis codes depending on the confirmed findings for PVD and claudication.<br />- If a diagnostic bilateral LE angiography turns into a unilateral intervention, the cath placement would drop and only the intervention would be billed, with a modifier required to override the edit.<br />- Intravascular Ultrasound is performed to assess vessel patency, structure, disease extent, and adequacy of therapy after intervention.<br />- 37185 can be billed bilaterally when it applies to the case.<br />- Atherectomy and thrombectomy can be billed separately with one device if done in different vessels. <br />- Modifier 51 may be applicable for reporting multiple interventions with appropriate codes.<br />- Catheter placements are not bundled with thrombolysis codes unless an intervention is performed. Diagnostic angiography is separately billable unless performed on a different vascular family.<br />- The CMS MUE for code 99153 is 9 units, but it applies to the facility, not the provider.<br />- If there is a switch from sedation to MAC due to complications, code 99152 can still be reported if at least 10 minutes of moderate sedation was performed by the provider.<br />- A duplex performed in the office does not negate the ability to do imaging in the OR.<br />- Modifier -59 may be necessary for codes 75716 and 75774 when required.<br />- CPT code 36225 is used for the head and neck area, and if findings of the vertebral circulation are given, it should be used. Otherwise, code 75710 or 75716 would be more appropriate.<br />- Each extremity is considered a family, with territories being the iliacs, femoral-popliteal, and tibial/peroneal.<br />- There is no separate code for shockwave balloon in peripheral cases. It would bundle with the primary intervention.<br />- Mechanical thrombectomy is separately billable according to the CPT book, but NCCI edits bundle it with other codes. A modifier may be allowed based on medical necessity.
Keywords
coding
peripheral angiography
intervention
bilateral modifier 50
angioplasty
stents
PVD
intravascular ultrasound
atherectomy
thrombectomy