Meet 3 Criteria to Bill Stent Placement With PTA Codes
Published on Sat Aug 07, 2004
Don't write off your physician's work if angioplasty of same lesion fails Suppose your interventional radiologist intends to perform angioplasty or atherectomy, but the intervention fails and he places a stent. Should you report the stent code only, or should you bill the angioplasty or atherectomy code as well?
If you meet three simple criteria, you should be able to collect for each procedure.
Normally, if radiologists perform angioplasty prior to placing a stent, insurers consider the angioplasty "pre-dilation" and will not separately reimburse for it. Similarly, if the physician performs atherectomy before placing the stent, the insurer will deny the atherectomy charge and consider it "debulking of the lesion."
Because payers bundle these services into stent placement payment, most radiology practices never bill angioplasty (35470-35476 with 75962-75968 or 75978 for radiological supervision and interpretation [RS&I]) or atherectomy (35490-35495 with 75992-75996 for RS&I) with stent placement (37205-37206 with 75960 for RS&I). 3 Tips Lead to Coding Success If your physician's note clearly documents the following three criteria, you can report your angioplasty or atherectomy with your stent codes, says Toni O'Neill, coder at Imaging Associates, a three-radiologist practice in Chicago:
1. The radiologist's intention to perform angioplasty as a primary intervention
2. Failed/suboptimal results from the angioplasty
3. Subsequent stent deployment. Renal Lesions May Not Warrant Separate Codes To bill multiple interventions of the same vessel, your physician's record must clearly establish angioplasty (or atherectomy) as his primary intention. But you probably won't be able to meet this criterion if the physician addresses lesions located at the origin of the renal arteries.
Most interventional radiology experts agree that physicians should only perform primary stenting if they treat orificial lesions (the most common lesions involving the renal arteries). If, before the physician even performs the procedure, he plans to stent the patient to treat orificial lesions, you should report only the stent codes, not percutaneous transluminal angioplasty (PTA).
"If a renal artery lesion (particularly one involving the renal artery ostium) is treated by angioplasty alone, re-stenosis is likely to occur," says Jackie Miller, RHIA, CPC, senior consultant for Coding Strategies Inc. in Powder Springs, Ga. "Stenting significantly reduces the likelihood of reoccurrence." Therefore, your interventional radiologist may perform primary stenting. Physician Intent Determines Code Note the physician's intent: Because the interventional radiologist knows from the start that he will stent the patient to treat orificial lesions, "You should report stenting of the renal artery with CPT 37205 (Transcatheter placement of an intravascular stent[s], [non-coronary vessel], percutaneous; initial vessel) and CPT 75960 (Transcatheter introduction of intravascular stent[s], [non-coronary vessel], percutaneous and/or open, radiological supervision and interpretation, each vessel)," Miller says.
When your physician performs interventions in other peripheral vessels (such as the superficial femoral [...]
