A: For lower extremity arterial revascularization, the choice of the primary code involving multiple interventions in the same vascular territory should be based on the intensity as determined by the relative value units (RVUs). One should report the highest valued RVU code as the primary code. For example, if a stent is placed in the anterior tibial and an atherectomy performed in the posterior tibial, the atherectomy (37229 – RVU value 14.05) would be the primary code and the stent (37230 – RVU value 13.80)* would be the add-on code.
The introductory notes of the 2011 CPT® codebook, p.208, provide the following coding guidance:
These lower extremity codes are built on progressive hierarchies with more intensive services inclusive of lesser intensive services. The code inclusive of all of the services provided for that vessel should be reported (i.e. use the code inclusive of the most intensive services provided).
The “intensity concept” translates to the RUC value of work and not to the numerical order of the base code in the CPT® codebook. Therefore, the increasing order of intensity for lower extremity arterial endovascular interventions is percutaneous transluminal angioplasty, stent, atherectomy, and stent/atherectomy based on the RUC survey data and the final Centers for Medicare and Medicaid Services work RVU content.
*Errata – The above incorrectly listed the stent add-on code as 37230 with an RVU value of 13.80. The correct stent add-on code is 37234 at an RVU value of 5.50. [Updated 3/10/11]