Hot Coding Topics

37228-+37235 Cover Your Tibial/Peroneal Service Codes

Facing denials on your tibial/peroneal codes? No worries, help is at hand.

The new tibial/peroneal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed.

The first four codes apply to the initial tibial or peroneal vessel treated in a single leg:

  • Angioplasty: 37228 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37229 — … with atherectomy, includes angioplasty within the same vessel, when performed
  • Stent (and angioplasty): 37230 – … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • Stent and atherectomy (and angioplasty): 37231 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

The final four codes are add-on codes that you use to report services on each additional ipsilateral (same side) vessel treated in the tibial/peroneal territory:

  • Angioplasty: +37232 — Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) (use with 37228-37231)
  • Atherectomy (and angioplasty): +37233 — … with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37229-37231)
  • Stent (and angioplasty): +37234 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37230-37231)
  • Stent and atherectomy (and angioplasty): +37235 — … with transluminal stent placement(s) and atherectomy, includes angioplastywithin the same vessel, when performed (List separately in addition to code for primary procedure) (use with 37231).

The general rule for the revascularization codes is that you should report the one code that represents the most intensive service performed in a single...

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February 21, 2011
CPT Medical Changes / Hot Coding Topics

Turn To 37224-37227 For Your Femoral/Popliteal Codes

CPT’s definition of a ‘single vessel’ for this territory is an exception to the rule.

CPT 2011 adds new codes for lower extremity endovascular revascularization covering angioplasty, atherectomy, and stenting, noted Stacy Gregory, CCC, CPC, RCC, of Gregory Medical Consulting Services, in her presentation, “Peripheral Vascular Coding Tactics,” at the 2011 Coding Update and Reimbursement Conference in Orlando (www.codingconferences.com).

This article focuses on the femoral/popliteal codes 37224-37227. “37220 to +37223 Revamp Your Iliac Intervention Coding Options” in Cardiology Coding Alert discussed the iliac codes. Look to a future issue to cover tibial/peroneal codes 37288-+37235.

The new femoral/popliteal service codes are below. Note that all of the codes include angioplasty in the same vessel when that service is performed:

  • Angioplasty: 37224 — Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
  • Atherectomy (and angioplasty): 37225 — … with atherectomy, includes angioplasty within the same vessel, when performed
  • Stent (and angioplasty): 37226 — … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • Stent and atherectomy (and angioplasty): 37227 — … with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

The general rule for 37224-37227 is that you should report the one code that represents the most intensive service performed in a single lower extremity vessel. All lesser services are included in that one code.

When the cardiologist performs a stent placement, atherectomy, and angioplasty in the left popliteal vessel, you should report only 37227.

That code covers stent placement, atherectomy, and angioplasty. You should not report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227 in this scenario.

As explained in the last issue of Cardiology Coding Alert, CPT guidelines state that — in addition to the intervention performed...

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January 19, 2011
Coding Challenge / Hot Coding Topics

2011 Guidelines For 93922

Question: I’m confused by the 2011 guidelines for 93922-93923. When should I report 93922-52? Answer: You should report 93922-52 (Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries … 1-2 levels; Reduced services)...

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January 19, 2011
CPT Medical Changes / Hot Coding Topics

CPT 2011: 37220 to +37223 Revamp Interventional Coding

Think outside the box for iliac atherectomy.

Are you ready to apply CPT’s new revascularization codes starting January 1? Check out these six tips to get you on your way.

CPT 2011 offers up new codes to help you report services more accurately, including endovascular revascularization, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Specifically, CPT 2011 adds several new codes that represent lower extremity endovascular revascularization, meaning angioplasty, atherectomy, and stenting. Here’s how the codes break down:

  • Iliac: 37220-+37223– Revascularization, endovascular, open or percutaneous, iliac artery …

  • Femoral, popliteal: 37224-37227– Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral …

  • Tibial/peroneal: 37228-+37235– Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral …

In this article, iliac artery services are the focus. Look to future articles to discuss femoral, popliteal, and tibial/peroneal services.

Watch Procedure and Vessel to Choose Among 37220-+37223

The new iliac service codes are as follows:

  • 37220– Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

  • 37221– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
  • +37222– Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

  • +37223– … with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure).

Reading through the definitions, you see that the codes for iliac services differ based on whether you’re coding a service in an initial vessel or in an additional vessel. Your options also differ based on whether you’re reporting (1) angioplasty alone or...

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January 12, 2011
Coding Challenge / radiology

Radiology Coding Education: Is 76705 OK for Back?

Question: For a lower back ultrasound of a soft tissue mass, which CPT code is appropriate? Answer: Code 76705 (Ultrasound, abdominal, real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is appropriate for this lower back ultrasound. Although the code descriptor states “abdominal” and not “back,” CPT Assistant (May 2009) clarifies that 76705 is appropriate [...] Related articles:

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November 2, 2009
Audit / Hot Coding Topics / Oig / RAC / radiology

Double Ultrasound Codes Spell Double Trouble With Auditors

Authorities scrutinize medical necessity for 76830 & 76856. The OIG is watching your ultrasound orders and code combinations — and it doesn’t like what it sees. Take note of these problem spots to keep your claims in the clear. An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims “had characteristics that raise [...] Related articles:

  1. OB or Not OB: That’s the Ultrasound Coding QuestionQuestion: For an ultrasound, the radiologist documented measurements of the uterus,...
  2. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  3. OIG Auditors to Cardiologist: You’re Billing Medicare ProperlyReport reveals what he and his billing staff did right....

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October 24, 2009