Atherectomy for Supra-Inguinal Arteries

The CPT coding changes in 2011 presented many challenges, especially for those physicians performing endovascular procedures. Cardiologists saw a complete overhaul of the right and left heart catheterization codes. Those cardiologists and surgeons who perform peripheral interventions saw a new series of CPT codes referred to as Endovascular Revascularization. This new series eliminated the component coding methodology for lower extremities and provided an all-inclusive series of codes. Fortunately, with these new codes, we also saw most major insurance companies develop payment models for atherectomies, stents, and angioplasties performed in the office setting. This resulted in higher reimbursement commensurate to the additional costs incurred by the physician’s office.

In addition, some less-known Category III codes were created for supra-inguinal atherectomies, which is the main focus of this article. First of all, Category III codes are alphanumeric codes used by CPT on a temporary basis for services that may be considered emerging technology. If you perform these atherectomy services, you will want to note some important coding guidelines that are different from the infra-inguinal services mentioned earlier. The following is an excerpt from the CPT Book explaining the use of these codes.

“These supra-inguinal atherectomy codes all include the surgical work of performing the atherectomy plus the radiological supervision and interpretation of the atherectomy. Unlike the atherectomy codes for infra-inguinal arteries, this set of Category III codes does not include accessing and selectively catheterizing the vessel, traversing the lesion, embolic protection if used, other intervention used to treat the same or other vessels, or closure of the arteriotomy by any method. These codes describe endovascular procedures performed percutaneously and/or through an open surgical exposure.”

Based on this one would expect to bill separately for the selective catheterization as well as other interventions one might perform to that lesion such as angioplasty and stent placement. But as noted by CPT, the supervision and interpretation portion is included in the atherectomy code. Below are the codes and their descriptions.

Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation
0234T: Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
0235T: visceral artery (except renal), each vessel
0236T: abdominal aorta
0237T: brachiocephalic trunk and branches, each vessel
0238T: iliac artery, each vessel.

It should be noted that Medicare currently views these procedures as investigational and does not provide separate reimbursement.  Before billing these codes, it is recommended that you contact your major payers to determine if they recognize these category III codes and that they will pay a higher rate when performed in the office setting.