Cardiology Coding Alert

Question: When I bill 37202 along with lower extremity arterials, the insurer denies the claim. For example, I billed 35470 (transluminal balloon angioplasty, percutaneous; tibioperoneal trunk or branches, each vessel), 37205 (transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel), 36247 (selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family) and 37202. Codes 35470, 37205 and 36247 were paid but 37202 (and its associated radiology code) was denied. Are there any coding policies or guidelines for billing 37202?

New York Subscriber

Answer: Transcatheter therapy is used to treat bleeding and spasm. The medication is infused over a period of 15 minutes or more, and must be supervised by a physician, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C. When medications such as nitroglycerin are injected during a diagnostic study of blood vessels or a therapeutic intervention of vascular disease, the injection is considered a preventive treatment to avoid spasm, not a treatment for the current spasm. In this situation, 37202 (transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive) is part of the diagnostic or interventional code and the service is not covered, according to American College of Cardiology and Medicare policies. Medicare specifically denies use of 37202 for any diagnoses other than:

430-432.9 hemorrhage, brain;
435.9 unspecified transient cerebral ischemia;
443.0 Raynauds phenomenon;
456.0 esophageal varices with bleeding;
456.20 esophageal varices in disease classified eelsewhere, with bleeding;
557.0 acute vascular insufficiency of intestine;
578.0 hematemesis;
578.1 melena; and
578.9 hemorrhage of gastrointestinal tract, unspecified.

Furthermore, 37202 specifically is not covered for these diagnoses:

410-414.00 ischemic heart disease;
415-417.9 pulmonary heart disease; and
440-447.9 diseases of arteries, arterioles and capillaries.

The ACC, in its Guide to CPT, specifies for routine infusions and/or injections, it is inappropriate to report this procedure using code 37202. The ACC notes, however, that 37202 may be billed under unusual circumstances, with modifier -59 (distinct procedural service) appended. Appropriate documentation showing the medical necessity for the distinct service should also be included in the claim.