Cardiology Coding Alert

If a patient has carotid artery stenosis, your cardiologist may choose to place an intravascular stent in the carotid artery to treat the condition. When you report the codes for carotid artery stenting, you must know all the different rules. For example, many services are bundled into the stenting codes, so you cannot report these services separately.

You have several code choices for carotid artery stenting.

These codes include 37215 (Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection) and 37216 (… without distal embolic protection).

“The difference between codes 37215 and 37216 is whether the provider places a distal embolic device during the procedure before the stent is placed,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “When the provider performs the stent in the cervical carotid artery, a distal embolic device can be placed that acts as a barrier to collect potentially harmful pieces of embolic debris, reducing the risk of a stroke.”

CPT^® also offers codes 37217 (Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation) and 37218 (Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation).

“When choosing between codes 37217 and 37218, look to the approach the physician takes to deliver the stent,” Peterson said. “Did the physician place the catheter through an open incision of the ipsilateral cervical carotid artery directing the catheter retrograde or did the physician direct the catheter antegrade through open incision or percutaneous approach to place the stent?”

Finally, you have code 61635 (Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed).

Don’t miss: If your cardiologist placed the stent in the cervical portion of the extracranial carotid artery, you should report codes 37215 and 37216.

If your cardiologist placed the stent in the intrathoracic common carotid artery of the innominate artery with retrograde treatment, you should report 37217.

If your cardiologist placed the stent in the intrathoracic common carotid artery of the innominate artery with an antegrade approach, you should report 37218.

On the other hand, you should report code 61635 if your cardiologist places the stent in the intracranial internal carotid artery.

Remember: “It’s important to know your terminology for ipsilateral, antegrade, and retrograde to understand these codes better,” Peterson said. “Ipsilateral means the same side, so if the provider takes an ipsilateral approach, they are performing the intervention on the same side as the catheter entry. Antegrade means to go with the normal direction of blood flow, so in this case the catheter is directed with the normal flow of blood circulation. Retrograde means to go opposite the direction of normal blood flow.”

Observe Services Included in Stenting

Since codes 37215-37218 and 61635 all include certain services, you should not report those services separately. All these codes bundle angioplasty with the stenting, so you should not report the angioplasty separately.

Codes 37215 and 37216: Codes 37215 and 37216 include “all ipsilateral selective carotid catheterization, all diagnostic imaging for ipsilateral, cervical and cerebral carotid arteriography, and all related radiological supervision and interpretation,” per the CPT^® guidelines. “When ipsilateral carotid arteriogram (including imaging and selective catheterization) confirms the need for carotid stenting, 37215 and 37216 are inclusive of these services.”

However, if your cardiologist does not perform carotid stenting, you should report the appropriate codes for carotid catheterization and imaging instead of codes 37215 and 37216.

Code 37217: Code 37217 includes the following:

• Open vessel exposure and vascular access closure
• All access and selective catheterization of the vessel
• Traversing the lesion
• Any radiological supervision and interpretation directly related to the intervention when performed
• Standard closure of arteriotomy by suture

Code 37218: Code 37218 includes all the ipsilateral extracranial intrathoracic selective innominate and carotid catheterization, all diagnostic imaging for the ipsilateral extracranial intrathoracic innominate and/or carotid artery stenting, and all related radiologic supervision and interpretation.

Code 61635: Code 61635 includes all selective vascular catheterization of the target vascular territory, all diagnostic imaging for arteriography of the target vascular territory, and all related radiological supervision and interpretation.

Don’t Forget These ICD-10-CM Codes for Carotid Artery Stenosis

If your cardiologist provides adequate documentation, you should select the appropriate carotid artery stenosis code from the following choices based upon whether the stenosis is in the right, left, unspecified, bilateral carotid arteries:

• I65.21 (Occlusion and stenosis of right carotid artery)
• I65.22 (Occlusion and stenosis of left carotid artery)
• I65.23 (Occlusion and stenosis of bilateral carotid arteries)
• I65.29 (Occlusion and stenosis of unspecified carotid artery). If your cardiologist doesn’t specify the side of the patient’s carotid stenosis, you should report I65.29.