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

Updated Webinar Slides

Pdf Summary

This MedAxiom bootcamp session reviews CPT coding concepts for lower extremity angiography and outlines major 2026 CPT structural changes for lower extremity revascularization (LER).<br /><br />The angiography section summarizes non-selective vs. selective catheterization coding rules, emphasizing that each leg is a separate vascular family below the diaphragm, catheterization is coded to the highest order within a family, and each access site may be coded separately. It reviews key diagnostic angiography codes (e.g., aortogram with runoff and unilateral/bilateral extremity imaging) and when 75774 may be billed for additional selective vessel imaging (only with medical necessity and imaging beyond the basic exam, not just extra views of the same vessel).<br /><br />For 2026, LER coding (37254–37299) is reorganized by “territories” within each leg (iliac; femoral/popliteal; tibial/peroneal; inframalleolar). Codes are unilateral and selected by territory, vessel treated, lesion complexity (straightforward vs. complex), and therapy type (angioplasty, stent, atherectomy, lithotripsy). Add-on codes apply only to distinct lesions in different vessels (not multiple lesions in the same vessel), and lesions spanning vessels are generally coded once (often using the more distal vessel rule). The materials also highlight evolving documentation expectations distinguishing stenosis vs. occlusion.<br /><br />Guidance is provided on when diagnostic angiography and catheterization may be separately reported with interventions (generally not billable through the same access unless specific criteria are met; separate puncture may allow separate reporting). Unsuccessful interventions are coded as diagnostic studies.<br /><br />Additional billable services discussed include ultrasound guidance for access (76937 with strict documentation requirements), IVUS (37252–37253), thrombectomy codes, embolization, thrombolysis, and moderate sedation (99152–99153) with documentation requirements including time and an independent trained observer.<br /><br />Multiple case studies illustrate proper code selection and modifier use (50, 59/X modifiers) for bilateral or distinct-leg procedures.

Keywords

Lower extremity angiography CPT coding

Selective vs non-selective catheterization rules

Aortogram with runoff coding

CPT 75774 additional selective imaging

2026 CPT changes lower extremity revascularization

LER territories iliac femoral popliteal tibial peroneal inframalleolar

37254-37299 revascularization code reorganization

Add-on codes distinct lesions different vessels

Ultrasound guidance for vascular access 76937 documentation

IVUS 37252 37253 and moderate sedation 99152 99153