Cardiology Coding Alert

Question: How should I report the procedures below from an antegrade approach for limb salvage?

• Diagnostic right superficial femoral angiogram with runoff 
• Right popliteal percutaneous transluminal angioplasty (PTA) and angiography 
• Right posterior tibial artery PTA and angiography

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Answer:  For the right popliteal PTA and angiography, you should report 37224 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal angioplasty).

For the right posterior tibial artery PTA and angiography, you should report 37228 (Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty).

Tip: The descriptors for both 37224 and 37228 specify "initial vessel." For these codes, "initial vessel" refers to an initial vessel in a territory (such as popliteal or tibial). Consequently, you can use two "initial" codes for the same encounter as long as each "initial" code applies to a different territory.

Codes 37224 and 37228 include necessary catheterization and radiological supervision and interpretation, so you should not report separate codes for those services, according to CPT® guidelines. 

You can report the diagnostic femoral angiogram with runoff separately as long as this was the initial diagnostic study and the interventional procedure wasn't staged or planned based on another study. In other words, the study must be a true diagnostic study under CPT® guidelines. For a unilateral study from a catheter in the femoral artery, use 75710-26 (Angiography, extremity, unilateral, radiological supervision and interpretation; Professional component). 

Correct Coding Initiative (CCI) edits bundle 75710 into both 37224 and 37228, so you'll need to append a modifier to 75710 to override the edit. You can use modifier 59 (Distinct procedural service) or XU (Unusual non-overlapping service).