Q: How do I code for intravascular ultrasound (IVUS) evaluation during a lower extremity arterial intervention, where IVUS was used to evaluate two lesions, one short segment lesion in the common iliac artery and one long segment lesion in the femoropopliteal region?
A: IVUS is reported once per vessel. It may only be listed one time per vessel even if the vessel is imaged multiple times during the encounter, such as before and after the intervention. 37252 [IVUS (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel] is assigned for the first vessel and 37253 [IVUS (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel] for each additional vessel examined. However, if IVUS is used to evaluate a lesion that extends from one vessel into another (e.g., common iliac lesion extending into the external iliac artery), this should be reported as examination of a single vessel. If completely separate lesions are evaluated in distinctly separate vessels (e.g., common iliac artery and superficial femoral artery), then each vessel may be coded separately. Please note that the external iliac and common femoral artery are considered one vessel as are the superficial femoral and popliteal arteries.
IVUS can be reported in conjunction with many different procedures, including diagnostic angiograms as well as therapeutic interventions. Refer to the list of base codes in the CPT® manual.
Q: Is coding for IVUS evaluation different during lower extremity venography procedures?
A: Reporting for IVUS evaluation is the same in both arteries and veins and is listed per vessel as defined in the previous question. Lower extremity venous vessels are defined as 1) common iliac vein, 2) external iliac and common femoral vein, 3) femoral and popliteal veins and 4) tibial veins (i.e., below knee).
Q: How do I code for IVUS evaluation during arteriovenous fistulograms?
A: IVUS evaluation of a dialysis circuit must be medically indicated. If medical necessity is met and IVUS evaluation is required in addition to a fistulogram (36901-6), IVUS evaluation (37252 and 37253) is reported according to one of three segments evaluated: arterial inflow vessel, peripheral venous segment (fistula/graft and peripheral venous outflow), and/or central venous segment. This is consistent with the existing fistulogram code set, in which interventions are reported according to peripheral or central segments (36901–36909).
Please note that any time IVUS is utilized, documentation regarding its indication for use, extent of use and findings must be included in the medical record (i.e., radiology report).
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2023/CPT®). It is not comprehensive and does not replace CPT®. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service. Please refer to 2023 CPT® for full and complete guidelines.
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