Coding for reimbursement depends on what was done and documented. In order for a claim to be processed by a payer, the appropriate CPT code must be submitted and supported by the documentation.
Documentation of interventional procedures must be described in detail:
The access site (puncture site)
The final position of the catheter tip within each vascular family
All preprocedural imagining
All therapeutic procedures performed
All supervision and interpretation services.
Revascularization procedures are coded in accordance with conventional radiology component billing guidelines, which allows for a wide variety of coding combinations. The surgical component is often found in the 3000 series CPT codes and the imaging with supervision and interpretation is found in the 7000 series CPT Codes.
There are multiple modifiers available for use with both CPT series. When providing supervision and interpretation it is important to know if the provider owns the equipment being used. If the provider does not own the equipment modifier 26 would be appended to the 7000 series CPT codes. Modifiers -51 for multiple procedures,-59 for distinct procedural service, -XU for unusual overlapping service, and, -XS for separate structure, and -50 for bilateral procedure are available for the 3000 series CPT code.
When coding for interventional procedures you start with the puncture site and the final position of the catheter tip within any given vascular family. A non-selective catheter is placed directly into an artery (e.g. Aorta). A selective catheterization the catheter tip is moved further into a branch (e.g. renal artery). Selective catheterization involves more effort and skill and is described as first, second, or third-order as the selectivity increases. Each order has a separate CPT code designated by the vascular family.
Example: Access was gained through the right common femoral artery, the catheter tip was placed in the aorta and an angiogram with bilateral runoff was performed. The provider does not own the equipment
In this case, you would code a non-selective catheterization of the aorta 36200 and abdominal aortography with bilateral runoff 75630-26
Example: Access was obtained through the right common femoral artery, the catheter tip was placed into the left common iliac and an angiogram was performed.
Report: 36245 selective catheter placement in first order, lower extremity artery branch, and 75710-26 for the unilateral angiography
Example: Access was obtained through the left common femoral artery. The catheter was guided into the right iliac artery and an angiogram was performed. The provider proceeded with angioplasty of the right common iliac artery.
Report 37220 for the percutaneous angioplasty of the right common iliac artery, the angiogram is included in the angioplasty and not separately reportable, as is the access of the left common femoral artery.
CPT guidelines instruct us to use codes 37220-37235 to describe lower extremity endovascular revascularization services for occlusive disease. These codes are hierarchial and they gain in intensity with each higher code. The lesser intensive services are inclusive of the higher intensive services and should not be reported separately. These codes include accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision and, interpretation, embolic protection, and closure of arteriotomy by device, pressure, or suture. Add-on codes are available to report additional vessels within a territory and should be reported separately as appropriate. Multiple lesions within the same vessel are reported with one CPT code.
There are codes available for open revascularization procedures performed via arteriotomy. There are many variables to consider when billing these services. Documentation is crucial to getting reimbursed for the services performed.
How does your documentation stand up to the standards? Are you getting reimbursed for the procedures you perform? Apex Practice Solutions has certified coders experienced in coding and billing for revascularization procedures and are available to assist in maximizing your reimbursement. Contact us today to see what we can do for you.