Originally Posted by mcallen
This is what I sent to my physician's for education.
Lower Extremity Revascularization
CPT 2011 completely restructured lower extremity peripheral vascular interventions. For starters, each lower extremity now has only seven recognized vessels and â€śin most casesâ€ť only one intervention can be reported in each of them.
CPT 2011 restricts us from coding for catheter placement (36140, 36245-36248), â€śin most casesâ€ť when necessary to perform an intervention â€“ even if the doctor first performs diagnostic angiography from the same access site.
In short order, here are those exceptions:
I. If a diagnostic study if performed from one access site and an intervention from a second access site it will still be appropriate to code the catheter placement from the diagnostic access site.
II. If an iliac atherectomy (0238T) is performed as a stand-alone procedure it will be appropriate to report the necessary catheter placement. Stand-alone iliac atherectomy means that no angioplasty or stent placement is performed in the same vessel and that no non-iliac atherectomy, lower extremity interventions are performed at the same access site.
III. When the iliac atherectomy is performed in the same vessel as angioplasty or stent placement it will be appropriate to report one code for the atherectomy in addition to the angioplasty and/or stent but no cath placement may be billed.
CPT 2011 has also restructured the way we can bill for diagnostic angiography. Diagnostic angiography performed at the time of an interventional procedure is separately reportable if:
I. No prior catheter-based angiography study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR
II. Prior study is available, but as documented in the medical record:
A. The patientâ€™s condition with respect to the clinical indication has changed since the prior study, OR
B. There is inadequate visualization of the anatomy and/or pathology, OR
C. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention
So if you want the catheter placement and diagnostic angiography billed â€“ youâ€™ll need to make a separate stick aside from the intervention.
Otherwise, I can still bill for the diagnostic angiography if you simply state the decision to intervene is based on the diagnostic study â€“ that seems to be the best solution. But anything listed above under â€śA, B, or Câ€ť will work as well â€“ please make sure it is documented in your surgery/procedure reports.
Bridging and Non-contiguous lesions
Bridged or non-contiguous lesion â€“ may be billed separately if the lesion extends across margins of one vascular territory into next and is treated by two separate and discrete interventions. However, I can only bill for one intervention if the lesion extends across margins of one vascular territory into next and is treated by a single intervention.
Please be specific as to what artery you are treating and please try to avoid, â€śatherectomy/stent/PTA was carried out on all vesselsâ€ť
FYI â€“ Per CPT: The common tibio-peroneal trunk is considered part of the tibial/peroneal territory, but it not separate, fourth segment of vessel. I can only bill for the TPT if itâ€™s the ONLY vessel treated.
FYI â€“ Per CPT: All vessels in the femoral-popliteal system are considered to be a single vessel in 2011.
Julie Graham, BA, CPC, CCC