Upper extremity interventional radiology coding can be a sinking area of challenge for coders and professionals alike with a quicksand of complexities that may leave professionals stuck or trapped in the nuances. These mistakes, even small, can be costly by tripping up coders, leading to lower payments, denials, and even potential compliance risks. One area selected by our subject matter experts for review is transluminal balloon angioplasty. Let’s explore the details for fortifying success in 2023 and beyond.
Analyzing Coding Basics: Arterial vs. Venous Procedures
What codes do we use for transluminal balloon angioplasty (arterial)?
Report codes 37246–37247 for angioplasty in arteries other than intracranial, coronary, pulmonary, and lower extremity for occlusive disease. In terms of angioplasty locations, coders should review 61630, 61635, 92920–92944, 92997, 92998, 37220–37235.
Understand that code 37246 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.
| 37246 | 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 |
| +37247 | 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) |
Coders should be careful not to report codes 37246–37247 for angioplasty in the aorta and visceral arteries in conjunction with fenestrated endovascular repair (34841–34848). So, what code exists for transluminal balloon angioplasty services related to venous? The following codes represent the service for venous:
| 37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein |
| +37249 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) |
Report code 37248 for venous angioplasty without stenting except within the dialysis circuit. Understand that code 37248 is reported for the first vein treated, and 37249 for each additional vein treated. Like the initial codes, if assigning the add-on code bilaterally report in units, do not assign modifier 50 to the add-on code. Do not report codes 37248 or 37249 for intervention in the tibial-peroneal segment when also reporting code 0620T for endovascular venous arterialization of the tibial or peroneal vein.
Coding Quick Facts
- Codes 37246–37249 describe open or percutaneous transluminal balloon angioplasty – conventional, low profile, cutting or drug-coated balloon.
- These codes were created for arterial vs. venous.
- Multiple angioplasties performed in a single vessel, including treatment of separate and distinct lesions within a single vessel, are reported with a single code.
- Lesions crossing the margins of two or more vessels, but can be treated with a single therapy, the intervention should be reported only once (aka, “bridging” or “contiguous” lesions).
- When additional, separate, and distinct ipsilateral or contralateral vessels are treated in the same session, 37247 and 37249 may be reported multiple times as appropriate.
- These codes are not bilateral. Report initial angioplasty with primary code and additional angioplasties using add-on codes.
- The codes include follow-up angiograms.
- When stenting and angioplasty both performed in the same vessel, report stent placement only.
What’s Not Included:
- Non-selective and/or selective catheterization is reported separately (36005, 36010–36012, 36200–36218, 36245–36248)
- Diagnostic angiograms
- Extensive repair or replacement of an artery may be reported separately (35226, 35286)
- Intravascular ultrasound may be reported separately (37252, 37253)
- Ultrasound for vascular access (76937) may be reported separately. This guideline is not in CPT but obtained via the AMA Symposium
- Mechanical thrombectomy and/or thrombolytic therapy when performed, may be reported separately (37184–37188, 37211–37214)
These are not all the essential coding tips and rationale for basic interventional radiology knowledge and upper extremities. As service volumes rebound and every dollar of reimbursement counts more than ever, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics, and break down the complexity with our expert-infused 2023 Upper Extremity Interventional Radiology Coding. This webcast is an essential training tool for both audio and visual learners.
