Angioplasty vs. Stent Placement

Question:

Our providers are using a self-expanding scaffold system that features integrated balloon dilation. This device is designed to temporarily support the artery, widening blockages, but the scaffold is retrieved at the end of the procedure, so no permanent implant remains. Such technology represents an innovation for treating peripheral artery disease, especially in cases with complex, calcified narrowing of lower limb arteries. Given that the scaffold is temporary and removed, my coding research indicates this procedure should be reported as angioplasty. Some device vendors suggest billing as stent placement. Is this accurate?

Answer:

For procedures using a temporary self-expanding scaffold with balloon dilation, where the scaffold is removed at the end and no permanent implant remains in the vessel, the intervention should be coded as angioplasty, not a stent placement. Stent placement codes are reserved for conventional stents that remain in the vessel as permanent implants, in accordance with CPT and major coding guidelines. Angioplasty codes are the correct choice when no permanent stent is left behind.

*This response is based on the best information available as of 9/25/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.

E/M for PAD with Ultrasound Order

Question:

How would we code for an established office visit for a patient with PAD and an order for an ultrasound?

Answer:

In terms of EM elements, PAD would support a chronic condition for a moderate problem, combined with an ultrasound (minimal risk) which would support a 99212 established visit.

*This response is based on the best information available as of 8/28/25.

Multiple Angioplasties

Question:

I’m new at coding, just out of vascular residency, and I have a question about reimbursement for a Medicare patient. If I do three angioplasties in the right leg, 37220 iliac, 37224 femoral-popliteal, and 37228 tibial, is 37228 paid at 100 percent and 37220 and 37224 paid at 50 percent?

Answer:

Per Medicare reimbursement policy that is correct. The 37228 tibial angioplasty pays the highest, so it is paid at 100%. The other 2 are each reduced by 50% for payment. This is the same anytime more than a single stand-alone CPT code is billed together. This is based on Medicare's multiple procedure payment reduction (MPPR) rule. Private payors typically follow this same payment policy but may vary, so check your payor policies.

*This response is based on the best information available as of 8/14/25.

DRIL Procedure

Question:

The surgeon said he did a DRIL procedure on an AC fistula. I’m not sure how to code this. Is it an unlisted code?

Answer:

The DRIL procedure (Distal Revascularization with Interval Ligation) is a surgical intervention to treat complications related to hemodialysis access. It is performed to address complications arising from hemodialysis access, such as ischemia (reduced blood flow) or steal syndrome (where blood flow is diverted away from the limb) in the affected extremity. It involves restoring blood flow to a limb while also addressing issues like high flow or steal syndrome by ligating (tying off) a portion of the access. This procedure aims to reduce pain, improve tissue viability, and prevent further complications in the affected limb. This procedure has an existing CPT code and is reported as 36838. 

*This response is based on the best information available as of 7/31/25.

Thrombolytic Infusion

Question:

If a thrombolytic infusion catheter is placed and later in the day it is removed for an interventional procedure and then replaced after the procedure, what is the correct code to report?

Answer:

CPT code 37211 is for the entire day of initial thrombolytic therapy. No additional code would be billed for catheter replacement on the same day.

*This response is based on the best information available as of 7/17/25.