Cardiology Coding Alert

Question: My cardiologist performed a cutting balloon atherectomy to the right femoral artery and to the in-stent restenosis of the left iliac artery. How should I code this? Minnesota Subscriber Answer: To assign the correct code to a peripheral service, you should assess the selectivity of the catheter position (which might be higher than the level of selectivity of the vessel in which the target lesion resides) or whether your cardiologist performed any diagnostic imaging during this procedure. Excluding discussion about coding catheter placement and diagnostic imaging, you should report the service you describe (cutting balloon atherectomy) as a simple angioplasty. A cutting balloon is an angioplasty catheter outfitted with three small blades mounted on the outside of the balloon. As the balloon expands inside a lesion, the blades cut into the lesion, making it easier to dilate. Without these blades, your cardiologist may not be able to perform the angioplasty because the lesion might have hardened (with plaque) over time. So although these balloon tips have blades on the outside, your cardiologist performed work similar to a traditional angioplasty. The correct codes for your scenario are:

Iliac - PTA(35473, Transluminal balloon angioplasty, percutaneous; iliac)
Radiological supervision and interpretation (75962, Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation)
Femoral - PTA(35474, Transluminal balloon angioplasty, percutaneous; femoral-popliteal)
Radiological supervision and interpretation (+75964, Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation [list separately in addition to code for primary procedure] [use 75964 in conjunction with code 75962]). Keep in mind: Words that end with "ectomy" reflect that the cardiologist removed something. For instance, atherectomy refers to removal of atheroscelerotic plaque. When your cardiologist uses cutting balloons, he does not remove the plaque. Instead, he simply cuts and dilates it in order to permit greater blood flow through the area of obstruction.