Cardiology Coding Alert


Split Femoro-Popliteal for 35474 Services

Question: Code 35474 refers to "femoro-popliteal" angioplasty. If the cardiologist treats both the femoral and popliteal arteries, should I report the code once or twice?

Oklahoma Subscriber

Answer: The answer depends on the location and nature of the lesion(s). If the patient had two distinct lesions, this equals two interventions, and you may report 35474 (Transluminal balloon angioplasty, percutaneous; femoro-popliteal) twice. If the patient has one long lesion that extends from the superficial femoral artery into the popliteal artery, this counts as one intervention, and you should report 35474 once.

Support: AMA's CPT Assistant (August 2006) states that "Since the inception of component coding for interventional radiology procedures, the femoral and popliteal arteries have been considered two distinct vessels. If there are distinct lesions found in both the femoral and popliteal arteries and each lesion is treated separately with Transluminal balloon angioplasty, CPT code 35474 would be reported twice."

You should append modifier 59 (Distinct procedural service) to the second code.

Catch this: According to CPT Assistant (December 2007), if one contiguous lesion bridges more than one vessel, this is one angioplasty service. You should "code for the vessel that is dominantly involved and treated." (Bonus tip: That same article explains that if the physician treats multiple lesions in a single artery, you should report only one angioplasty service for that artery.)

RS&I: Don't forget to report the related radiological supervision and interpretation code(s): 75962-26 (Transluminal balloon angioplasty, peripheral artery, radiological supervision and interpretation; Professional component) for the first vessel and +75964-26 (Transluminal balloon angioplasty, each additional peripheral artery, radiological supervision and interpretation [List separately in addition to code for primary procedure]) for the second.

If you use the same vascular access point site for both interventions (which is typical), you should report the appropriate selective catheterization code only once. For example, if the doctor accessed the right common femoral artery and advanced the interventional catheter into the contralateral (left) superficial femoral and popliteal arteries, you would report code 36247 (Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family).

-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, CCC, CPC, ACS-CA, CHCC, president of www.CardiologyCoder.Com.