2011 Cpt Updates: Get The Payments For Femoral/Popliteal Revascularization

You shouldn't miss the 'single vessel' exception.

See to it that your surgery practice is all geared up to implement the overhaul of endovascular revascularization coding.

CPT 2011 adds news codes for lower extremity endovascular revascularization, including angioplasty, atherectomy, and stenting.
v Here's a lowdown of femoral/popliteal codes 37224-37227.

Master the single code approach for Fem/Pop Coding

You should get familiar with the following new femoral/popliteal service codes and remember that all of the codes include angioplasty in the same vessel when that service is performed:

Angioplasty: 37224 --
Atherectomy (and angioplasty): 37225 -- . . .
Stent (and angioplasty): 37226 --
Stent and atherectomy (and angioplasty): 37227

Remember: The general rule for 37224-37227 is that you should use the one code that represents the most intensive service carried out in a single lower extremity vessel. All lesser services are covered in that one code.

For instance: When your surgeon carries out a stent placement atherectomy, and angioplasty in the left popliteal vessel, you should go for only 37227. This code covers stent placement, atherectomy, and angioplasty. You shouldn't report 37224 (angioplasty), 37225 (atherectomy), or 37226 (stent placement) separately or in addition to 37227 in this particular scenario.

Make use of this territory rule to stay away from denials

The new peripheral revascularization codes (37220-+37235) apply to different 'territories'. Each and every territory has its own specific set of guidelines. 37224-37227 fall under the femoral/popliteal vascular territory.

Key rule: According to CPT, "the entire femoral/popliteal territory in one lower extremity is taken as a single vessel for CPT reporting." So you should use a single code even if the surgeon performed different interventions for various lesions in the popliteal artery and in the common, deep, and superficial femoral arteries in the same leg during the same session.

In these scenarios, you should code for the most difficult service.

For instance: If the surgeon carries out angioplasty in the left popliteal artery and atherectomy in the left common femoral, you should go for only atherectomy code 37225.

Remember: The codes are unilateral, meaning they apply to a service on a single side of the body. According to CPT, if the doctor treats the identical territory (such as femoral/popliteal) in both legs at the same session, you should go for modifier 59 (Distinct procedural service) to show both legs are involved.

However you should watch out for payers' modifier preferences. Some may want you to use modifier 50, modifiers RT and LT or some combination of modifiers for procedures on both legs.

The change from component coding

As per CPT guidelines, in addition to the intervention carried out, the codes include

Accessing the vessel
Catheterizing the vessel selectively
Crossing the lesion
Radiological supervision and interpretation for the intervention carried out
Any embolic protection utilized
Closure of arteriotomy (incision in the artery)
Imaging carried out to document the intervention was done.

For instance: Last year, you reported a superficial femoral artery angioplasty via antegrade puncture using now deleted code 35474, 36245, and 75962. This year, you should report only 37224 to cover all of the services.

Remember: If the doctor performs mechanical thrombectomy, thrombolysis or both, to help restore blood flow to the occluded area, CPT states that you may report those services separately.

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