Radiology Coding Alert

Reporting the proper intravascular ultrasound (IVUS) code won't do you any good unless you know to report it with a primary procedure. And you could be foregoing hard-earned cash if you forget to report supervision and interpretation, too.

The service: Physicians use IVUS in peripheral arteries to diagnose problems such as the amount of plaque burden and the amount of calcium in the vessel wall. Physicians may use IVUS during interventions (such as atherectomy or stent placement) or to assess treatment results. During an IVUS, the physician places a special ultrasound catheter in the vessel to visualize its structure.

Peripheral IVUS codes are add-on codes, so don't try reporting them without the accompanying primary service or you'll face denials, says Jennifer Bankhead, RHIT, CPC-H, CIC, specialized coding analyst for St. Joseph's Mercy Hospital in Hot Springs, Ark.

In other words: "Because you'll be using add-on codes, you have to match them up to the correct primary codes," says Yvette Hofmeister, CPC, coding analyst for OSU Internal Medicine in Columbus, Ohio.

Add peripheral vessel IVUS codes +37250 (Intravascular ultrasound [non-coronary vessel] during diagnostic evaluation and/or therapeutic intervention; initial vessel [list separately in addition to code for primary procedure]) and +37251 (... each additional vessel), as appropriate, to peripheral interventions.

Example: You would report 37205 (Transcatheter placement of an intravascular stent[s] [except coronary, carotid, and vertebral vessel], percutaneous; initial vessel) as the initial vessel primary code and 37250 as the initial vessel IVUS add-on code.

If you're not sure which peripheral vessel the radiologist performed the IVUS in, ask the physician, because this must be in the notes for insurers to pay, Bankhead says.

Peripheral IVUS codes 37250 and 37251 do not include imaging supervision and interpretation (S&I).

So if the radiologist interprets peripheral IVUS images, bill 75945 (Intravascular ultrasound [non-coronary vessel], radiological supervision and interpretation; initial vessel) for the initial vessel interpretation with 37250, and add +75946 (... each additional non-coronary vessel [list separately in addition to code for primary procedure]) to 37251 to report the additional vessel interpretation.

Note: If you are coding coronary artery -- rather than peripheral vessel -- IVUS, you should use a single code to report both IVUS catheter placement and imaging supervision and interpretation.

Choose from +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report, initial vessel) or +92979 (... each additional vessel).

Although an IVUS has obvious diagnostic applications, some carriers may be reluctant to pay for this study. If you demonstrate appropriate medical necessity for the visualization service with a primary procedure, however, you may have an easier time convincing payers to reimburse.

Example: A physician may note that an angiography study does not clearly reveal whether plaque is significantly narrowing a vessel and may document that the IVUS yields a more accurate assessment of the degree of narrowing.

In addition, IVUS can give more information about plaque pathology, such as the presence of significant calcium, a thrombus or dissection within the artery. Your physician can use these details to guide the appropriate interventional therapy, so you should look for this information in the procedure note.