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• W2148998364 abstract "Placement of an iliac artery stent can be done through standard percutaneous access or after surgical cutdown in the operating room. The latter situation may require direct arterial repair with polyprolene suture or a more extensive intervention such as endarterectomy and/or patch angioplasty using autogenous or prosthetic material. The term “open stenting” refers to a situation wherein the interventionalist makes a limited incision, isolates the artery for direct puncture to establish access, deploys the stent, repairs the vascular defect directly, and then closes the surgical wound. “Open” does not refer to the vessel treated. Rather, it denotes the method of endovascular access. The new 2011 lower extremity arterial intervention CPT codes are applicable for either open or percutaneous stenting. When an “open stent” is performed, it is not appropriate to additionally report the “direct blood vessel repair” code descriptions (eg, CPT code 35226, “Repair blood vessel, direct; lower extremity”) to depict control of the access site. Also, these procedures have a 0-day global period such that evaluation and management on a subsequent day after treatment is not subject to bundling restrictions. Endovascular stent placement within the iliac artery requires use of a base code for the initial vessel (CPT code 37221). If an additional ipsilateral artery is treated within that same territory, the add-on iliac stent CPT code 37223 is submitted in addition to the base CPT code. The term “iliac” incorporates intervention on the common, external, or internal iliac arteries. Since there are three potential vessels, the add-on code can be reported a maximum of once (when two vessels are treated) or twice (when three vessels are treated) in a given territory. As these CPT code descriptions were designed for ipsilateral intervention, the base code is submitted twice when bilateral therapy is undertaken such as “kissing” common iliac stents (CPT code 37221 twice). A special notation was added to the introductory wording for instruction on reporting therapy when a single intervention crosses territories or spans two vessels in an area that has add-on coding available. It states, “If a lesion extends across the margins of one vessel vascular territory into another, but can be opened with a single therapy, this intervention should be reported with a single code despite treating more than one vessel and/or vascular territory.” In contrast, more extensive lesions with plaque burden in both the common and external iliac arteries do not fall under these guidelines since the vascular specialist must plan his/her therapy for each vessel. Covered stents are considered identical to bare metal implants from a coding perspective in these locations when treating atherosclerotic arterial occlusive disease. Common femoral (CPT code 35371), iliofemoral (CPT code 35355), superficial femoral (CPT code 35302), or deep femoral (CPT code 35372) endarterectomy may be performed in addition to any endovascular treatment. Only one of the four open surgery CPT codes listed above is reported per groin treated. These include clot extraction, when performed (hence the term “thromboendarterectomy” in the CPT manual). Also, patch closure of the vessel with either prosthetic or autogenous material is bundled with endarterectomy (and this also includes the vein patch harvest with subsequent wound closure, if performed). If the lower extremity artery is addressed by patch without endarterectomy, CPT code 35256 is fitting for vein patch while CPT code 35286 is appropriate for “other than vein” which includes prosthetic material or a piece of endarterectomized superficial femoral artery. When the endovascular and open surgical procedures are accomplished in the same setting, both services may be reported and are subject to the multiple procedure discount. The iliac stent CPT codes 37221 and 37223 must have the −59 modifier appended for payment when submitted with an endarterectomy or a patch angioplasty. That modifier certifies that the stent was performed in an area separate and distinct from the artery treated with open surgery." @default.
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• W2148998364 date "2011-08-01" @default.
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• W2148998364 title "Iliac artery stenting combined with open femoral endarterectomy is as effective as open surgical reconstruction for severe iliac and common femoral occlusive disease" @default.
• W2148998364 doi "https://doi.org/10.1016/j.jvs.2011.06.078" @default.
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