The use of intravascular ultrasound (IVUS) can provide helpful information for assessment of pre- and post-intervention vascular status and, thus, is an important part of the management of patients with arterial and venous disease. IVUS can provide information about lesions not evident with angiography or standard ultrasound. Correct coding of IVUS depends on anatomic considerations in addition to accurate documentation of the procedure and findings.
For Current Procedural Terminology (CPT) 2016, the surgical and interpretation components of IVUS were combined into two new bundled codes for reporting IVUS in the initial noncoronary vessel (37252) and each additional noncoronary vessel (37253). IVUS codes may be reported in addition to any angiographic or interventional procedure codes when treating peripheral arteries and/or veins.
Certain principles of documentation and vascular nomenclature will help inform the use of and number of units of IVUS that may be reported for any given intervention; specifically, one unit of service for each IVUS procedure for each vessel (vessels are defined in Appendix L of the CPT codebook). In other words, separate coding for a pre- and post-intervention IVUS examination is not permitted. The number of units of IVUS reported is based on the number of vessels studied and includes all work necessary to perform the procedure. While it is possible to code for each vessel studied, when a lesion spans two different vessels those two vessels are considered a single vessel. For example, a stenosis involving the external iliac vein that continues into the common iliac vein would be coded as one vessel. This is based on CPT codebook guidelines for characterizing anatomic definitions of vessels and applies to IVUS and other procedures.
Documentation must support the number of units of IVUS reported. Each vessel, with laterality specified, needs to be included in the documentation. In addition, the physician must describe the IVUS findings for each vessel before and after any intervention. Quantification of percentage stenosis is always helpful as documentary support for the intervention and the use of IVUS.
As is always the case, the clinical indications for the procedure should support the use of IVUS technology in each vessel that is being studied. When performed, IVUS is included in IVC (inferior vena cava) filter placement, repositioning and removal, and foreign body retrieval and should not be separately reported with these procedures.
Physicians who use advanced technologies such as IVUS to improve outcomes for their patients should be reimbursed accordingly. The guidance provided is designed to facilitate the documentation and coding for use of this technology.
There may be situations where questions arise regarding the proper documentation and coding for more complex lesions and anatomic features. For help, email [email protected].