Question Lithotripsy during TAVR

Bonnie Owen

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I apologize if this is a duplicate post. Issues with the Forum today. Can you bill for a peripheral lithotripsy during a TAVR? I cannot find any written information on this one way or the other. This is pro fees and looking at an unlisted CPT code but I hear it is considered COS of TAVR. Please advise and give resources. Thank you
 

cpc2007

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Hi

This is a great question! There is no code for vascular lithotripsy specifically for profee billing (there are some HCPCS codes for facilities to bill this charge). From my research, a peripheral lithotripsy such as femoral or iliac lithotripsy should not be coded purely for catheter access for the TAVR. Unless they are treating a hemodynamically significant stenosis (50% or greater of vessel diameter), no codes would be reported. If they do treat a hemodynamically significant stenosis, that is a therapeutic procedure and not purely for access, and you could code the lower extremity revascularization procedure such as an angioplasty (e.g., 37224) that was performed with the aid of lithotripsy. I haven't found anything official from AMA or CMS on this topic, but I did find this guidance from well-respected vascular consultants like Z Health Publishing.

I hope that helps :)

Kim
www.codingmastery.com
 

Bonnie Owen

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Thank you Kim. Found a question to Z Health and there was a response but I could not view it because I am not a member any more. Question ID#15015. Do you know how he responded? Thank you. I was looking at coding 93799 unlisted with 37224 for another one; not TAVR.
 

cpc2007

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You're welcome! Same general response which I would agree with as well. If performed just for access, and they are not treating a hemodynamically significant stenosis (at least 50%), do not report anything for the lithotripsy angioplasty. If there is pathology supporting treatment in a peripheral artery (i.e., a stenosis of at least 50%), you can add the 37224 or appropriate lower extremity revascularization code like stent or atherectomy.

Kim
 
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