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.

Same Group Coding

Question:

If an Electrophysiologist performs a 90-day procedure and an Interventional Cardiologist in the same group sees the patient mostly for the reason for procedure, can he bill an EM, if yes, would a modifier be necessary?

Answer:

The Interventional Cardiologist can generally bill an E/M (Evaluation and Management) service during the 90-day global period of a procedure performed by the Electrophysiologist in the same group — but only if certain conditions are met and modifier 24 is applied correctly.

Since both physicians are in the same group, they're typically considered the same provider for billing purposes. The key is demonstrating that the Interventional Cardiologist's service was separate, medically necessary, and not just a routine post-procedural visit that would normally be included in the global surgical package.

The documentation should clearly support why this additional E/M service was necessary and distinct from the typical care associated with the procedure.

*This response is based on the best information available as of 7/03/25.

Selective or Non-Selective Catheterization

Question:

If we access the dorsalis pedis artery with a catheter and go up into the anterior tibial for arteriogram, is this selective or non-selective?

Answer:

This would be a non-selective catheterization; the access was made and did not cross into the aorta or into another territory for selective catheterization.

*This response is based on the best information available as of 6/19/25.