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Cardiology Coding Alert

Reader Questions:

Coding 2 Atherectomies in the Same Leg

Published on Mon Nov 22, 2004

Question: If a physician performs atherectomy in the posterior tibial and tibioperoneal trunk (same leg), are these separately reportable? If so, how should I modify or otherwise identify the artery/branch?

South Carolina Subscriber
 
Answer: You should report peripheral interventions "per vessel." You'll find speculation about what constitutes a vessel (that is, named vessel versus vessels divided by a bifurcation). 
 
This is only a concern in those anatomic places where the vessel name changes when it crosses an anatomic landmark. For example, the external iliac becomes the common femoral where the vessel crosses the femur. The superficial femoral artery becomes the popliteal where it crosses the knee.
 
However, the tibioperoneal trunk is a separate vessel by both name and bifurcation (i.e., the short vessel begins where the popliteal splits into the anterior tibial and the tibeoperoneal trunk). This short vessel then terminates where it bifurcates into the posterior tibial and peroneal arteries.
 
Therefore, each intervention should be separately reported. The only modifier that would be applicable to differentiate these interventions is modifier -59 (Distinct procedural service).

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