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Stent and Atherectomy in the Femoral and Popliteal Arteries
If a stent is placed in the common femoral artery and an atherectomy is performed in the popliteal artery, can both codes be billed?
Question:
If a stent is placed in the common femoral artery and an atherectomy is performed in the popliteal artery, can both codes be billed?
Answer:
The femoral/popliteal is one territory, so angioplasty, atherectomy and stent are reported with one code regardless of the number of interventions performed. CPT code 37227 represents stent and atherectomy within the same vessel and also includes angioplasty when performed.
*This response is based on the best information available as of 2/13/25.
Modifier for Bilateral Catheterization
Do you code bilateral catheterization codes with modifier 50?
Question:
Do you code bilateral catheterization codes with modifier 50?
Answer:
Catheterization codes below the diaphragm can be coded with bilateral modifier 50, however, catheterization codes above the diaphragm should be coded with modifier 59 on the second code. (ex. Lower extremity 36245-50, upper extremity 36215, 36215-59).
*This response is based on the best information available as of 1/30/25.
Discrepancy between Procedure Title and Documentation Details
If the details of a procedure documentation do not match the listed procedure/operation that was planned, which procedure code should be selected?
Question:
If the details of a procedure documentation do not match the listed procedure/operation that was planned, which procedure code should be selected?
Answer:
CPT codes are always chosen based on the documentation within the detailed portion of an operative record. If the details within the body of the report do not match the “procedure title” listed in the beginning of the operative report, the provider should be queried for clarification and a possible addendum to the record if necessary.
*This response is based on the best information available as of 1/16/25.
Modifier 80 vs 82
What is the difference between modifier 80 and modifier 82 when a physician is acting as an assistant during surgery?
Question:
What is the difference between modifier 80 and modifier 82 when a physician is acting as an assistant during surgery?
Answer:
While both modifier 80 and modifier 82 are used when a physician is actively participating as an assistant to a primary surgeon during a surgical procedure, modifier 82 is used in teaching or university hospitals that have approved Graduate Medical Education (GME) programs for Residents. In these teaching hospitals, there must be documentation indicating that no qualified resident was available to assist, to allow for another physician to act as the assistant surgeon, and then modifier 82 is appended to that assistant surgeon.
*This response is based on the best information available as of 1/2/25.
Pre-op vs Post-op Diagnosis
Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?
Question:
Is there a difference between a pre-operative diagnosis and a post-operative diagnosis?
Answer:
Pre-operative diagnosis is based on the “Reason for the surgery” or the condition affecting the patient leading to the necessity of the surgery. Underlying co-morbidities that can affect the surgical outcome or represent a risk to the patient can also be included but the documentation must support their relationship to the patient risk.
Post-operative diagnoses are based on the findings determined during the surgical procedure. Post-op diagnosis may be the same as the pre-op diagnosis or may be more definitive.
*This response is based on the best information available as of 12/19/24.
Intravascular Ultrasound (IVUS)
How do we code for intravascular ultrasound of lower extremity vessels? Can it be billed along with the placement of a lower extremity stent?
Question:
How do we code for intravascular ultrasound of lower extremity vessels? Can it be billed along with the placement of a lower extremity stent?
Answer:
Intravascular Ultrasound (IVUS), CPT code +37252 (noncoronary) and +37253 (noncoronary) for each additional vessel, can be coded when vessels are examined during a diagnostic procedure or before, during, or after a therapeutic intervention (e.g., stent or stent graft, angioplasty, atherectomy, embolization, thrombolysis, transcatheter biopsy). However, if a lesion extends across the margins of one vessel into another, only one code should be reported. These add-on codes must be reported with the appropriate base code. IVUS is included in the work of CPT codes 37191, 37192, 37193, and 37197 for intravascular vena cava filter (IVC) and should not be reported separately with those procedures.
*This response is based on the best information available as of 12/5/24.