Question:
For lower extremity revascularization, utilizing angioplasty, stent placement, and/or atherectomy, what is the hierarchy of treatment for coding?
Answer:
Codes for lower extremity revascularization are assigned according to a hierarchy of treatment for each of the three territories (iliac, femoral/popliteal, tibial/ peroneal). The order of least extensive to most extensive treatments is:
- Angioplasty
- Stent placement (includes angioplasty if performed)
- Atherectomy (includes angioplasty if performed)
- Atherectomy with stent placement (includes angioplasty if performed). Within a single territory, the code for the most extensive treatment should be assigned first, even if that was not the first procedure performed.
Note that the codes in the CPT® Manual are not in the same order as the above hierarchy, so be sure to code according to the hierarchy and not by the highest-numbered CPT code.
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