On Demand: Navigating the New CPT Structure for Lower Extremity Revascularization-Presentation Slides

Presentation Slides

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This MedAxiom presentation provides an in-depth overview of the 2026 CPT coding changes for lower extremity revascularization (LER) procedures, effective January 1, 2026. It addresses updated CPT codes and coding rules for angiography, catheterization, and interventions such as angioplasty, stenting, atherectomy, lithotripsy, embolization, and thrombolysis related to peripheral arterial disease and vascular interventions in the lower extremities.<br /><br />Key points include:<br />- CPT codes 37254-37299 now cover unilateral LER procedures, categorizing the lower extremity arteries into four vascular territories: iliac, femoral/popliteal, tibial/peroneal, and inframalleolar. Each territory has specific codes for straightforward and complex lesions and initial versus additional vessels treated.<br />- Only distinct lesions in different vessels warrant separate add-on codes; lesions crossing vessel boundaries but treatable with a single therapy must be coded as one intervention.<br />- Diagnostic angiography codes are not billed concurrently with intervention codes if performed through the same access site, barring different arterial punctures.<br />- Coding includes detailed catheterization guidelines, emphasizing coding selective over non-selective catheterizations and imaging to the foot before billing additional vessel imaging.<br />- Moderate sedation codes (99151–99153) apply when an independent trained observer is present and closely monitoring the patient, with documentation of sedation times required.<br />- Additional billable services include ultrasound guidance for vascular access (76937), intravascular ultrasound (37252, 37253), thrombectomy (37184-37186), embolization (37241-37244), and thrombolysis (37211, 37213, 37214).<br />- Several clinical case studies demonstrate application of these coding rules, illustrating appropriate use of catheterization, angiography, intervention, imaging, sedation, and associated modifiers for bilateral procedures or multiple vessel treatments.<br />- The presentation reiterates that CMS and payers have yet to release official 2026 policy updates; thus, these guidelines are educational and subject to change.<br /><br />Overall, the session equips coders and clinical teams with comprehensive updated CPT coding knowledge for accurate documentation and billing of LER procedures in 2026.

Keywords

2026 CPT coding changes

lower extremity revascularization

LER procedures

angiography coding

catheterization guidelines

vascular interventions

peripheral arterial disease

moderate sedation codes

ultrasound guidance

thrombectomy and embolization