Cardiology Coding Alert

Question: When doing an iliac angioplasty and iliac stent in the same session, which procedure can you bill and which codes do you use?

Anonymous Subscriber, LA

Answer: You may bill for both the iliac angioplasty and the iliac stent. Medicares reimbursement policy for a peripheral vascular procedure differs from that for coronary arteries. With the latter, Medicare will only pay for the most complex intervention per coronary artery system.
Use these CPT codes for an iliac angioplasty with stent:

1. Use 35473 for percutaneous transluminal angioplasty (PTA) iliac

2. Use modifier -51 with 37205, intravascular stent initial vessel because it is the second main procedure.

3. Depending on cath placement, select one of the following:
36247, cath placement, 3rd order, OR
36246, cath placement, 2nd order, OR
36245, cath placement, lst order

4. Use 37206 for each additional intravascular stent. (However, remember that 37206 is reimbursed at a higher rate than 36245, cath placement 1st order.)

5. Use modifier -26 with 75630, aortography, plus bilateral iliofemoral lower extremity, to represent the professional component only. Likewise, attach modifier -26 to these codes:
75960, stent S & I,
75962, PTA radiological S&I,
76964 PTA radiological S& I.

6. Finally, use 36248, for each additional cath placement of the 2nd, 3rd order and beyond. (Remember to attach modifier - 52 to code 75630-26, if the iliac angiogram is unilateral.)