Coding Principles for Percutaneous Peripheral Vascular Interventions

Theory and practice regarding component coding.

By Alan B. Lumsden, MD, and Eric Peden, MD
 

Lower-extremity interventions can be among the most complex and lengthy procedures performed. The ischemic limb may even require repeated interventions over the course of several days. Furthermore, a dramatic increase in the number of lower-extremity interventions is projected during the next 5 to 10 years. For these reasons, it is fiscally prudent, and legally necessary, that procedures are correctly coded. We outline our approach to lower-extremity interventional coding and provide examples of commonly encountered scenarios.

COMPONENT CODING
Peripheral vascular interventions are reported using "component" coding. Most other services have "bundled" or inclusive coding to report both medical and surgical procedures. CPT* coding impacts reimbursement for outpatient hospital services and ambulatory surgical center (ASC) services under both Medicare and private insurance systems. Clearly, it is critical to report procedures accurately.

Component coding for peripheral interventions consists of two broad code sets:

  • Surgical (technical) codes–30000 series (describe "What I did")
  • Supervision and interpretation (S&I) codes–70000 series (describe "What I found")

These codes allow for the identification of separate procedural aspects from the imaging aspects and describe them as separate services.

When dictating procedural notes, we find it helpful to adhere to the following template:

  • Diagnosis: describe both preoperative and postoperative diagnoses, noting any change from the preoperative to the postoperative. Provide the indication for the procedure to be performed.
  • Procedure: describe the technique, including all of the following factors. Separate different parts of the procedure into different paragraphs for ease of coding.
    • Catheter access point (eg, right femoral)
    • Catheter endpoint for each vascular family (eg, third-order left anterior tibial, second-order left popliteal)
    • Procedure(s) performed (eg, angioplasty of the left posterior tibial artery)

Radiologic S&I: State all vessels imaged (even those not catheterized) and state imaging performed for any interventional procedures

RULES TO LIVE BY
The following are some of our personal "rules to live by" when coding claims for percutaneous peripheral vascular interventions:

Access

  • Only the highest-order catheterization within a vascular family is coded.
  • Single access for multiple services can be coded only once.

Treatment

  • Vessels treated separately can be coded separately.
  • Distinct interventional services can be coded separately.

Imaging and S&I

  • Imaging can be reported separately from the intervention itself.
  • Preprocedural diagnostic angiography is coded separately; postprocedural evaluation is not.
  • Imaging codes, both technical and S&I, usually include all necessary views.

Using Modifiers
Modifiers can be extremely confusing, but they can play an important role in accurate coding and appropriate reimbursement. We follow the recommendations of the American Medical Association and also refer to the Society of Interventional Radiology (SIR) for modifier guidance.

CASE EXAMPLES
To illustrate the application of these "rules" in actual practice, consider the following case studies. (See PDF)

CONCLUSION
The coding scenarios presented here represent the way that we would code these procedures in our practice. Obviously, technique and device choice, as well as coding methodology, is personal to each physician and patient scenario, and we are not recommending any one therapy or coding methodology over another.

Procedural coding methodologies will differ slightly for each physician due to differences in interpretation, definition of services, and the varying needs of payers. However, if we all adhere to a basic set of coding principles, the services we are providing will be reported as accurately as possible, and we and our facilities are more likely to be reimbursed appropriately.

Given the complexity of coding for percutaneous peripheral vascular procedures, our goal in outlining the coding principles that we "live" by is to initiate an ongoing dialogue regarding coding and reimbursement that will enable us and the facilities we work with to learn from one another and to continuously update and improve our practices.

Alan B. Lumsden, MD, is from Baylor College of Medicine, in Houston, Texas. He has disclosed that he holds no financial interest in any product or manufacturer mentioned herein. Dr. Lumsden may be reached at (713) 798-2151; alumsden@bcm.edu.
Eric Peden, MD, is from Baylor College of Medicine, in Houston, Texas. He has disclosed that he holds no financial interest in any product or manufacturer mentioned herein. Dr. Peden may be reached at (713) 798-2151; epeden@bcm.edu.

 

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