Cardiology Coding Alert

Question: CCI bundles 37236 and 37246. I code for a physician who frequently performs angioplasty and stenting in the aorta and renals. How should I code the stenting?

Florida Subscriber

Answer: The answer depends on whether the encounter involves angioplasty and stenting in both the aorta and a renal vessel, or involves angioplasty in one vessel and stenting in the other.

Stent in both: If the encounter involves both angioplasty and stenting in each of two distinct vessels, then angioplasty code 37246 (Transluminal balloon angioplasty [except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit], open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery) would not be appropriate.

Any angioplasty that occurs in the same vessel as stent placement is included in stenting code 37236 (Transcatheter placement of an intravascular stent[s] [except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary], open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery).

For each additional artery with stent placement, report +37237 (…each additional artery [List separately in addition to code for primary procedure]), which also includes same-vessel angioplasty.

Stent in one: There is a Correct Coding Initiative (CCI) edit pair with column 1 stent code 37236 and column 2 angioplasty code 37246.

The edit has a modifier indicator of 1, which means you can override the edit by using a modifier on the column 2 code. Documentation must support overriding the edit, showing, for instance, that the stenting took place in one artery while the angioplasty without stenting took place in a distinct artery.

Keep in mind: The CPT^® guidelines for both 37236 and 37246 include this line: “If a lesion extends across the margins of one vessel into another, but can be treated with a single therapy, the intervention should be reported only once.”