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Iliac Angioplasty and Stent Coding: Per Vessel or Per Lesion?
The surgeon documented angioplasty and stents for occlusive disease in the right common and external iliac arteries. Is this reported with one or two codes?
Question:
The surgeon documented angioplasty and stents for occlusive disease in the right common and external iliac arteries. Is this reported with one or two codes?
Answer:
That depends! Coding is reported per lesion, not per vessel. So, if a single lesion extends across the two iliac vessels, external and common, only one code is reported, 37221. However, if two separate and distinct lesions are in these two vessels, separately treated with angioplasty and stents, then two codes may be reported, 37221 and +37223. Documentation of two separate and distinct lesions will be key!
*This response is based on the best information available as of 4/10/25.
Inpatient Consultation Coding for Medicare
If you see a Medicare patient for the first time in the hospital as an inpatient consultation, what code would you bill for the EM?
Question:
If you see a Medicare patient for the first time in the hospital as an inpatient consultation, what code would you bill for the EM?
Answer:
The EM would be reported as an Initial hospital or observational care codes (99221-99223) with the appropriate level based on MDM or Time. Medicare does not allow payment for inpatient consultation codes 99252-99255.
*This response is based on the best information available as of 3/27/25.
Is documentation of HPI and Exam Necessary in Determining a level of E/M?
With the 2021 and 2023 Guideline changes, is it necessary to document an HPI and Exam when neither counts towards the level of service?
Question:
With the 2021 and 2023 Guideline changes, is it necessary to document an HPI and Exam when neither counts towards the level of service?
Answer:
As described in the most recent AMA E/M guidelines, documentation of a history of present illness (HPI) and an exam are no longer required to contribute to the level of an E/M service. Today, documentation of medical decision making, or time are the sole determinants supporting a level of E/M. E/M documentation should include a medically appropriate history and examination. While the nature and extent of the history and exam is to be determined by the clinician, they add to the medical necessity of the visit and provide a more complete representation of the patient condition for continuity and coordination of care with other clinical providers.
*This response is based on the best information available as of 3/13/25.
Non-Selective vs Selective Catheterization
What is the difference between non-selective and selective catheterization?
Question:
What is the difference between non-selective and selective catheterization?
Answer:
Non-selective catheterization is when the catheter remains in the accessed vessel site (puncture site) and is not navigated further into other vessels. Selective catheterization is when the catheter is manipulated out of the access vessel, or out of the aorta, to additional vessels.
*This response is based on the best information available as of 2/27/25.
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.