Cardiology Coding Alert

Coders can toss out the cardiology coding rule book when billing for peripheral intervention (PI), says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. "Coding PI is completely different from what cardiology coders are used to," she says.
 
Relatively few procedures are bundled when PI is performed; therefore, detailing everything the cardiologist did is essential to accurate coding and reimbursement.
 
When the cardiologist places a stent in a coronary artery, for example, only the stent may be billed (in most cases) even if the procedure began as a percutaneous transluminal coronary angioplasty that subsequently required stenting. In this situation, report 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous, with or without other therapeutic intervention, any method; single vessel) because any other intervention in the same vessel or vessel family is included in the stent.
 
In peripheral vessels (such as the superficial femoral artery), the stent and its associated supervision and interpretation (S&I) code may be reported separately with the percutaneous transluminal angioplasty (PTA) as long the stent was not planned and the PTA was not performed simply to provide access for the stent. In addition, catheter access codes are payable separately.
 
A superficial femoral PTA that required stenting might be coded as follows (assuming retrograde sheath placement):

  37205 Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; initial vessel

  35474 Transluminal balloon angioplasty, percutaneous; femoral-popliteal

  36247 Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family

  75710 Angiography, extremity, unilateral, radiological supervision and interpretation

  75960 Transcatheter introduction of intravascular stent(s), (non-coronary vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel

  75962 Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation.
 
Note: Code 37205 must be reported first, since it is the highest-paid procedure.
Reimbursement for PI can be significant because they are billed by the component: While the coronary stent (92980) is assigned 21.84 relative value units (RVUs), the superficial femoral stent and its separately payable components total 36.31 RVUs.
 
Note: If a diagnostic left heart catheterization (93510) or coronary angiogram (93508) is performed prior to the placement of the coronary stent, it may be reported separately. In such cases, the appropriate injection code (93539-93545) and S&I code (93555-93556) may also be billed. If a diagnostic catheterization has been performed and coronary angiography or left heart catheterization is performed with the stent, it is included in the stent placement.
 
The same types of interventions are performed in coronary and peripheral arteries: angioplasties, stents and atherectomies. Peripheral PTAs or atherectomies are performed on patients with obstructive atherosclerotic lesions in the lower extremities (iliac, femoral or popliteal arteries) or the upper extremities (the innominate, subclavian, axillary or brachial arteries). Other arteries [...]