Question 1

How do you handle coding for an endovascular procedure that starts with a diagnostic angiogram and then proceeds to an intervention (angioplasty/stent)?

Accepted Answer

This is a key complexity. We code the diagnostic angiogram separately using the appropriate radiology code(s) for the vessel(s) studied. If the decision to intervene is made during the diagnostic study and performed in the same session, we append modifier -59 (or a more specific XU modifier) to the diagnostic code to indicate it was a distinct service. The intervention is then coded with the appropriate therapeutic codes (e.g., 37220-37235). This ensures both components are reimbursed correctly.

Question 2

What is your approach to coding for atherectomy procedures, which can have varying reimbursement policies?

Accepted Answer

We are very familiar with the varying payer policies for atherectomy. We code for the specific atherectomy performed (e.g., 37225 for femoral/popliteal atherectomy). Crucially, we ensure the documentation clearly supports the medical necessity for atherectomy over angioplasty alone, and we are aware of payers that may bundle atherectomy with angioplasty or have specific frequency limitations. We also ensure proper use of add-on codes for additional vessels.

Question 3

How do you handle billing when a diagnostic angiogram leads to immediate intervention during the same session?

Accepted Answer

When a diagnostic angiogram is performed and the decision to intervene is made in the same session, we apply modifier -59 (or the more specific -XU modifier) to the diagnostic angiography codes to indicate they are distinct services. The intervention is then coded with its standard therapeutic codes. We carefully review the operative report to confirm the diagnostic study was truly medically necessary as a standalone service before the intervention decision, since some payers bundle the diagnostic component when the decision to intervene was made before the procedure.

Question 4

Can you manage billing for hybrid open-endovascular vascular procedures?

Accepted Answer

Yes. Hybrid procedures combine open surgical exposure (e.g., common femoral endarterectomy) with endovascular intervention in the same session. We code each component separately — the open surgical procedure using its standard CPT code and the endovascular intervention using the appropriate percutaneous intervention code — and verify that both components are separately reportable under CCI edits. We also manage the documentation requirements that justify billing both an open and endovascular component, protecting your practice during any payer audit.

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