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IVUS coding per vessel

Super Posted Wed 10th of June, 2015 09:59:41 AM

per guidelines the IVUS in the veins is coded per vessel. Our Doc works ipsilateral, so his access vessel is the R & L com fem generally. He advances the tip of the cath bilaterally into the IVC and does pullback recording ivus of com iliac, ext iliac and com fem on R and L sides. No crossover work. All ipsilatera, I code 37250 75945 on R and 37251 75946 on L. As an access vessel is 1 vessel and in this case he is not in another vessel in that family unless he goes into the internal iliac or when he enters the IVC. So I am giving one ivus on each side. I do give cath placement in IVC bilaterally 36010 x 2 as both catheter tips are taken into the IVC. Another point is from a diagnostic standpoint the ext iliac and com fem are consider one vessel as they between bifurcations. So if it is per vessel being this is diagnostic study, how many IVUS would it be. The other coder uses 37250 x1 and 37251 x 5 counting each R com iliac, Rext iliac and R com fem, same on the left for total of 6 IVUS. please advise.

SuperCoder Answered Thu 11th of June, 2015 02:20:32 AM

Intravascular ultrasound (IVUS) is the use of ultrasonic guidance and imaging during an intravascular procedure. IVUS is used before and after a therapeutic intervention on a non-coronary artery or vein to assess patency (check to see if the vein or artery is open) and integrity (no puncture wound, tearing, etc.) of the vessel.
According to CPT coding guidelines, IVUS should be counted per vessel or per vein. For example, if IVUS is performed in four vessels/veins, four units should be reported for this procedure. If IVUS is performed before and after a procedure in four vessels/veins, only four units should be reported. Only one unit is reported per vessel/vein during an operative session.

Per the CPT descriptor for codes 37250 and 37251, procedure code 37250 is used to report the initial vessel/vein treated. Each additional vessel/vein treated should be reported using procedure code 37251.

When the radiological supervision and interpretation for IVUS is also performed, codes 75945 and 75946 should be reported in addition to codes 37250 and 37251. The units for codes 75945 and 75946 are counted in the same manner as the units are counted for codes 37250 and 37251. Count the number of vessels/veins treated, not the number of times IVUS is performed in each vessel/vein.

Per the CPT descriptor for codes 75945 and 75946, procedure code 75945 is used to report the initial vessel/vein treated. Each additional vessel/vein treated should be reported using procedure code 75946. The number of units reported for code 75946 should equal the number of units reported for code 37251.

Super Posted Mon 15th of June, 2015 14:12:18 PM

Here is my question. Is the access vessel considered 1 vessel until he goes more selective? In this case access is in com femoral vein, so unless he goes into the IVC or the internal iliac vein he is still just in the one access vessel, he has not selectively entered another vessel. So if he does IVUS on the Rt in that access vessel without going selective is it one IVUS(for entire access vessel as one) or 2 IVUS one for each vessel within your access vessel, the common iliac and one for the ext iliac/com fem, as diagnostically those 2 are the same vessel?

SuperCoder Answered Tue 16th of June, 2015 02:23:43 AM

IVUS codes are used for each of the major coronary arteries studied, but not for branches. For example for five recognized cardiac vessels (LD, LC, RC, LM, RI) there could be up to four additional vessels. There would NOT be 7, 8, or 9 to include branches also.

Super Posted Fri 26th of June, 2015 16:03:24 PM

The question was not regarding coronary artery IVUS it was regarding work in the veins of pelvic and lower extremities. Is the access vessel considered 1 vessel until he goes more selective? In this case access is in com femoral vein, so unless he goes into the IVC or the internal iliac vein he is still just in the one vessel? if he ulrasonds from the IVC pulling back to his com fem access point, ipsilateral, is that one IVUS 37250 or is it one IVUS 37250 for common iliac and one 37251 for external iliac? He has not selectively entered another vessel.

SuperCoder Answered Mon 29th of June, 2015 02:52:12 AM

You can code both the codes 37250 and 37251. Though the access was through one vessel, the provider performed ultrasound all through from the IVC pulling back to his com femoral. So you can take CPT 37250 for IVS of the common iliac and CPT code 37251 for IVUS of external iliac.

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