A new year means new challenges in coding. Yet many coders, especially new coders, struggle time and time again with very basic details that encompass services. Interventional radiology is tough, especially for these coders. Loaded with nuances and complexities, it can be a sea of endless confusion to navigate in the fast-paced world of healthcare. Balloon angioplasty is one area targeted by our experts for fundamental review. Let’s examine the details to bolster accurate understanding in 2024 and beyond.
Balloon Angioplasty Service Analysis
How is balloon angioplasty performed? Angioplasty using a balloon catheter that is inflated inside an artery, stretching the intima and leaving a ragged interior surface after deflation. This has cascading impacts resulting in a healing response and breaking up of plaque.
In the realm of medical procedures, angioplasty has come a long way since its inception by Dr. Dotter. Originally involving a series of progressively larger catheters to dilate arteries, today’s approach utilizes a specialized catheter equipped with an attached balloon. This catheter, initially inserted with the deflated balloon, navigates through a patient’s arteries or veins to address stenosis or occlusion resulting from atherosclerosis.
Once the balloon reaches the narrowed area, it undergoes inflation, effectively pushing the plaque against the artery or vein wall. This action facilitates improved blood flow in the affected region. Depending on the circumstances, the procedure may need repetition, utilizing either the same or different-sized balloons.
For coding purposes, it’s crucial to note that angioplasty is coded once per vessel, regardless of the number of inflations. If there are multiple stenoses within a single blood vessel, and each undergoes angioplasty treatment, only one angioplasty code set should be assigned. In some cases, a stenosis may extend from one artery or vein to another, referred to as a “bridging” lesion. If one angioplasty successfully addresses both arteries, only one code set is assigned. However, if separate inflations are required in distinct arteries, individual codes should be assigned for each.
Occlusion is not the only reason that angioplasty is performed. These other reasons include:
- dissection (tear) of an artery
- or vein during a procedure
The angioplasty codes would still apply to these scenarios.
Note that use of a cutting balloon does not change the codes assigned, it is still considered an angioplasty. Similarly, if a report documents “cryoplasty,” it is coded as an angioplasty.
When a stent is placed, do not code for an angioplasty procedure within the same artery or vein, even if separate areas are treated. Understand that codes for vascular catheterization and diagnostic angiogram may be separately assigned. Ultrasound guidance for vascular access (76937) and intravascular ultrasound (IVUS) (37252, 37253) may be coded separately when appropriately documented.
CPT ®delivers several options for bundled codes for angioplasty without stenting. Coders may be questioning whether you can still use codes associated with open and percutaneous codes for specific artery angioplasty in 2024. These previously established codes well as the generic venous angioplasty were deleted. Coders should know that these codes are not specific to location, and include the following:
- any type of open or percutaneous balloon angioplasty,
- including low profile, cutting balloon,
- drug-coated balloon,
- or conventional angioplasty.
These codes include the angioplasty procedure and imaging necessary to complete the procedure. Catheterization codes (non-selective or selective for non-occlusive lower extremity arterial disease), IVUS, mechanical thrombectomy, and/or thrombolysis may be reported separately if performed. Extensive repair or replacement of an artery may also be reported if necessary.
Analyzing More Accurate Coding Assignment Scenarios
There are several instances where these codes should not be reported. Do not report angioplasty separately when a stent is also placed in the same artery or vein, even when separate lesions are treated. Report angioplasty only once per artery or vein regardless of the number of lesions treated. If additional arteries or veins are angioplastied, report the “each additional” codes (37247, 37249) for each additional artery or vein.
Bridging, or contiguous, lesions are those that extend from one artery or vein into another. When a bridging lesion can be treated as a single procedure, report the appropriate angioplasty code only once even though two vessels are treated.
Do not report these codes for angioplasty within the dialysis graft/fistula circuit. See codes 36902– 36908 instead.
|Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery
|Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure)
Report codes 37246–37247 for angioplasty in arteries other than intracranial, coronary, pulmonary, and lower extremity for occlusive disease. Look to codes 61630, 61635, 92920–92944, 92997, 92998, 37220–37235 for angioplasty in these locations. When using code 37246, understand that it is reported for a single artery angioplasty, or the first artery of multiple arterial angioplasties. Report code 37247 for each additional artery angioplastied at the same session. If assigning the add-on code bilaterally report in units, do not assign modifier 50 to the add-on code.
Do not make the mistake of reporting codes 37246–37247 for angioplasty in the aorta and visceral arteries in conjunction with fenestrated endovascular repair (34841–34848). Understand that in 2023, CMS created code C7532 for ASC practices. Coders should be warned that this code is not to be used for either physician. or OPPS/facility coding.
When documenting angioplasty procedures in arteries, excluding intracranial, coronary, pulmonary, and lower extremity arteries affected by occlusive disease, assign codes 37246–37247. For angioplasties in these specified locations, refer to codes 61630, 61635, 92920–92944, 92997, 92998, 37220–37235.
Code 37246 is applicable for a singular artery angioplasty or the initial artery in cases of multiple arterial angioplasties. Code 37247 should be reported for each additional artery angioplastied during the same session. If applying the add-on code bilaterally, report in units; refrain from using modifier 50 on the add-on code.
Codes 37246–37247 must not be employed for angioplasty conducted in the aorta and visceral arteries concurrently with fenestrated endovascular repair (34841–34848).
These are NOT all the tips and tricks necessary to tackle basic interventional radiology coding. As service volumes rebound and every dollar of reimbursement counts more than ever in the face of payment cuts, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding pain management topics and break down the complexity with our expert-infused 2024 Basics of Interventional Radiology Coding webcast. This webcast is an essential training tool for both audio and visual learners.