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

Updated Webinar Slides

Pdf Summary

This MedAxiom bootcamp session reviews lower extremity angiography and explains major 2026 AMA CPT structural changes for lower extremity revascularization (LER) coding, emphasizing that payer (CMS) guidance may lag.<br /><br />For angiography/catheterization, it distinguishes non-selective (36140, 36200) from selective catheter placements (36245–36248). Each leg is treated as its own vascular family below the diaphragm, and coders should report the highest order selection per family and code each access separately. Imaging codes highlighted include abdominal aortography with runoff (75630), abdominal aortography plus unilateral/bilateral extremity imaging (75625 with 75710 or 75716), and selective additional vessel imaging (75774) only when medically necessary after the basic exam.<br /><br />For 2026 LER interventions (37254–37299), the presentation outlines bundled services (access/catheterization to perform the intervention, intraprocedural imaging guidance, embolic protection, and closure). Coding is unilateral and organized by “territories” per leg: iliac; femoral/popliteal; tibial/peroneal; and inframalleolar. Codes are selected per territory, with initial-vessel codes and limited add-on codes only for distinct lesions in different vessels (not multiple lesions in the same vessel). Guidance addresses lesion classification (stenosis vs occlusion; “complex” vs “straightforward”) and instructs that when a lesion crosses vessels/territories but is treated with a single therapy, report one code for the more distal vessel.<br /><br />It also clarifies when diagnostic angiography and catheterization may be separately reported during an intervention (e.g., no prior study or changed clinical situation) and how to apply modifiers for bilateral work. Additional separately billable services reviewed include ultrasound guidance for access (76937 with strict documentation), IVUS (37252–37253), thrombectomy, embolization, thrombolysis, and moderate sedation (99151–99153) with documentation requirements. Multiple case studies demonstrate code selection and modifier use.

Keywords

lower extremity angiography

2026 AMA CPT changes

lower extremity revascularization coding

catheterization codes 36140 36200 36245 36248

vascular family selection rules

runoff angiography 75630

abdominal aortography 75625 75710 75716

selective vessel imaging 75774

LER territories iliac femoral popliteal tibial peroneal inframalleolar

bundled services modifiers bilateral IVUS 37252 37253 ultrasound guidance 76937 moderate sedation 99151 99153