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Transcript of Lower Extremity Revascularization Coding and its Relationship to Vascular Access Procedures ASDIN...
![Page 1: Lower Extremity Revascularization Coding and its Relationship to Vascular Access Procedures ASDIN Coding University 1.](https://reader036.fdocuments.us/reader036/viewer/2022062308/56649d745503460f94a542bd/html5/thumbnails/1.jpg)
Lower Extremity Revascularization Coding and its
Relationship to Vascular Access Procedures
ASDIN Coding University
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New Concept
• Prior to 2011, angioplasty and related procedures in the lower extremity were coding in the same manner as those in the upper
• In 2011 the Lower Extremity Revascularization (LER) coding system was introduced
• While not designed for dialysis vascular access, some of its principles do have an effect
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Generalities About the LER System
• The arteries of the lower extremity are divided into 3 vascular territories:– Iliac – Femoral/popliteal – Tibial/peroneal
• Each territory has a unique set of codes assigned
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Hierarchical System of Coding
• The series of codes 37220-37235 are to be used to describe lower extremity endovascular revascularization services performed for occlusive disease
• These lower extremity codes are built on progressive hierarchies with more intensive services (stenting, atherectomy) being inclusive of lesser intensive services (angioplasty)
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Example
• The lowest level code is for angioplasty • If this is followed by stent placement, another code
is recorded that includes the lower level• In this instance only one code would be used to
represent both procedures
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All Inclusive• Each of the codes used is all inclusive except for the
diagnostic angiogram which is coded separately • Each individual code includes:– Non-selective cannulation– Selective catheterization– Radiological supervision and interpretation (RS&I)– Embolic protection if used– Closure of the arteriotomy by any method– Imaging performed to document completion of the intervention
in addition to the intervention(s) performed.
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Iliac Vascular Territory
• The iliac territory is divided into 3 vessels: – Common iliac– Internal iliac– External iliac
• Lesions in each of these vessels can be coded for a maximum of three
• A single code is used for each vessel treated
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Codes for the 1st Vessel Treated
• For the first artery with a lesion that is treated:– 37220 - Revascularization, endovascular, open or
percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty
• If a stent is required, this code would be dropped in favor of:– 37221 - With transluminal stent placement(s), includes
angioplasty within same vessel, when performed
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Codes for Additional Arteries in Iliac Territory
• +37222 –angioplasty (List separately in addition to code for primary procedure)
• +37223 – transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
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Important Principle• Up to 2 add-on codes can be used in a unilateral iliac
vascular territory since there are 3 vessels which could be treated
• Add-on codes are used for different vessels, not distinct lesions within the same vessel
• Multiple lesions within the same vessel would receive a single code for all
• If lesions are also present in the contralateral leg, these would be coded independently, this system relates to a single extremity
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Femoral/Popliteal Vascular Territory
• The entire femoral/popliteal territory in 1 lower extremity is considered a single vessel for coding purposes
• A single code is used no matter what combination of angioplasty/stent/atherectomy is applied to any segments, including the common, deep and superficial femoral arteries as well as the popliteal artery
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The Codes• 37224 - Revascularization, endovascular, open or
percutaneous, femoral/popliteal artery(s), unilateral; with transluminal angioplasty
• 37225 - With atherectomy, includes angioplasty within the same vessel, when performed
• 37226 - With transluminal stent placement(s), includes angioplasty within the same vessel, when performed
• 37227 - With transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
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Important Principle
• Since only a single vessel can be coded, there are no add-on codes for additional vessels
• Because only 1 service is reported when 2 lesions are treated in this territory, the most complex service (e.g., highest level code) should be recorded
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Tibial/Peroneal Territory
• The tibial/peroneal territory is divided into 3 vessels:– Anterior tibial artery– Posterior tibial artery– Peroneal artery
• Lesions in each of these vessels can be coded for a maximum of three
• A single code is used for each vessel treated
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The Codes for the 1st Vessel Treated
• 37228 – Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal angioplasty
• 37229 – With atherectomy, includes angioplasty within the same vessel, when performed
• 37230 - With transluminal stent placement(s), includes angioplasty within the same vessel, when performed
• 37231 - With transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed
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Codes for Additional Arteries in This Territory
• +37232 – each additional vessel; transluminal angioplasty
• +37233 – atherectomy, includes angioplasty within the same vessel
• +37234 - stent placement(s), includes angioplasty within the same vessel
• +37235 - transluminal stent placement(s) and atherectomy, includes angioplasty
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More than two Vessels With Territory
• If an additional lesion is present in a third vessel within the territory, the appropriate add-on code would be used with a 59 modifier attached
• A maximum of three individual codes, one for each vessel, can be recorded
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Lesion that Bridges Territories
• If a lesion extends across the margins of one vascular territory into another, but can be opened with a single therapy, this intervention should be reported with a single code despite treating more than one vessel and/or vascular territory
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Additional Points
• When the same territor(ies) of both legs are treated in the same session, modifiers should be used to describe the interventions – Use modifier 59 to denote that different legs are being
treated, even if the mode of therapy is different
• Mechanical thrombectomy and/or thrombolysis in the lower extremity vessels are sometimes necessary to aid in restoring flow to areas of occlusive disease, and are reported separately
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LER Affects on Vascular Access Coding
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Arterial Angioplasty in Lower Extremity Access
• The arterial anastomosis of the vascular access is classified as the arterial portion of the access
• If an angioplasty is performed in this region in the lower extremity, LER coding system must be used
• This will generally be the femoral-popliteal territory– The code for angioplasty alone – 37224– If a stent is also performed – 37226 (as single code)
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Cannulation/Catheterization• If a thigh graft has an arterial lesion that is treated:– The non-selective cannulation code should not be recorded,
it is bundled with the LER code for the arterial angioplasty procedure
– The angiogram code would be record separately (75791)
• If a second non-selective cannulation is performed it should be coded as 36147, it is the 1st codable cannulation of the access – with a 59 modifier– The angiogram code would need to be dropped because it is
now included in the cannulation code
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Important Note• This document is for informational purposes only and
should serve as a guideline for appropriate coding.• The ultimate responsibility for correct coding
/documentation remains with the provider of service. • ASDIN makes no representation, warranty, or guarantee
that this compilation of information is error-free, nor that the use of this guide will prevent differences of opinion or disputes with CMS or any other carrier.
• ASDIN will bear no responsibility or liability for the results or consequences that may grow out of the use of this guidance.
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