Cardiology Coding Alert

Question: How should I code external iliac and common femoral angioplasty stent procedures? Would it be only 37221? Or may I also code 37226?

Codify Member

Answer: If the physician performed separate therapies for the iliac and femoral arteries, you should report both 37221 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement[s], includes angioplasty within the same vessel, when performed) and 37226 (Revascularization, endovascular, open or percutaneous, femoral, popliteal artery[s], unilateral; with transluminal stent placement[s], includes angioplasty within the same vessel, when performed).

Support: The iliac and femoral arteries are considered to be separate territories for these codes. Coding guidelines state, "When multiple vessels in multiple territories in a single leg are treated at the same setting, the primary code for the treatment in the initial vessel in each vascular territory is reported."

Caution: In some cases, a lesion may cross from one territory to another but the physician will be able to treat the lesion with a single therapy. In that case, "this intervention should be reported with a single code despite treating more than one vessel and/or vascular territory." When choosing your code, keep in mind that the relative value units (RVUs) for 37226 are higher than those for 37221. When there is a break in stenosis and multiple stents are deployed then you may (dependent on the documentation) be able to code two territory procedural codes.