CPT Coding Guidelines Review: Endovascular Revascularization of Lower Extremities

This is a series of blogs about the importance of being familiar with CPT coding guidelines. Often there is extensive guidance preceding a subsection or range of codes for particular procedures, but coders are very busy so sometimes they jump right into the codes without taking time to review these guidelines, even though following or not following their direction could significantly affect the accuracy and comprehensiveness of coding.

This series is designed to help you become familiar with guidelines for significant procedures that you might not be acquainted with but do impact coding. The presentations are short and meant to generate awareness of the guidelines that are available in CPT rather than the application of guidelines to specific coding scenarios.

This installment of the series explores the guidelines related to CPT coding for endovascular revascularization of the lower extremities

CPT Guidelines for Endovascular Revascularization of Lower Extremities

Please watch this video to learn about the guidelines that provide direction in assigning CPT codes for endovascular revascularization of the lower extremities.

Take Aways

• Endovascular revascularization codes are built on a progressive hierarchy where more intensive services are inclusive of less intensive services
• Balloon angioplasty is included in all procedures of higher intensity
• Many parts of the surgical process, such as arterial exposure and closure are included in the codes for endovascular revascularization
• Codes are available for treatment in three vascular territories: iliac, femoral/popliteal and tibial/peroneal
• The segments of the femoral/popliteal arteries are considered a single vessel for the purposes of coding endovascular revascularization procedures in CPTThe most complex service within a territory is reported with a primary code. Interventions in additional vessels within a territory are reported with add-on codes.

Test Your Knowledge

For detailed explanations of the quiz answers, please refer to the end of this blog post.

Additional Coding Education: Invest in You!

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Quiz Answers and Rationale

Question 1: The correct CPT code assignment is 37227 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed. The femoral/popliteal territory is considered a single vessel. When coding multiple interventions in a single vessel, assign the primary code for the most complex service reflective of combining the interventions performed in that vessel, which in this case in atherectomy with stent placement. When more than one stent is placed in a vessel, only one stent related code is assigned. This is supported by the description of code 37227 which says. “…transluminal stent placement(s)…”. Balloon angioplasty is not reported separately because it is included in the atherectomy with stent placement codes 37227.

Question 2: Report a primary code and an add-on code when lesions at bifurcations within the tibial/peroneal vascular territory require therapy of 2 distinct branches. The same is true if coding for interventions in the iliac territory. When coding for the femoral/popliteal territory, it is correct to report a single code for the most intensive service.

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.