Don’t miss out on coding and billing for IVUS. The purpose of this article is to simplify the rules for documentation requirements, so you will capture deserved reimbursement and remain compliant in case of an audit.
Per the 2022 National Medicare Physician Fee Schedule:
CPT CODES AND DESCRIPTIONS
+ 37252 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel
+ 37253 each additional noncoronary vessel
Important coding considerations:
- Codes are assigned based on the vessel(s) evaluated
- Medical Unlikely Edits (MUEs) are limited to a quantity of one (1) for 37252 and a quantity of five (5) for 37253
- IVUS codes include radiological supervision and interpretation
- Catheter placements are separately coded
ADD-ON CODES: 3 SPECIFIC CODING/BILLING INSTRUCTIONS APPLY
Both codes are designated as add-on codes. The + symbol preceding each code indicates IVUS can only be done in addition to a primary procedure performed by the same physician. Under Instructions for Use of the CPT Codebook, CPT provides coding/billing guidelines for the use of Add-on Codes.
Per CPT 2022 Professional Edition, page xvi:
- “The add-on code concept in CPT applies only to add-on procedures or services performed by the same physician.”
- “Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone.”
- “Do not report modifier 50, Bilateral procedures.”
WHEN IVUS IS INCLUDED AND CANNOT BE SEPARATELY REPORTED?
Per CPT instructions immediately preceding codes 37252 and 37253, IVUS cannot be reported with the following procedures:
37191 Insertion IVC filter
37192 Repositioning IVC filter
37193 Removal IVC filter
37197 Intravascular foreign body retrieval
- Anytime insertion, repositioning, or removal of an IVC filter or intravascular foreign body retrieval is performed, IVUS cannot be coded.
WHEN IVUS CAN BE ADDITIONALLY REPORTED?
CPT provides a list of base codes that permit the assignment of IVUS codes. In the 2022 CPT Code book, immediately following 37252 and 37253, you will find a list of 181 codes that permit the assignment of an IVUS code. Notice procedures such as 37241-37244 embolizations, 37220-37235 lower extremity revascularizations, and 36901-36909 dialysis circuit interventions are included on this list.
- Before assigning an IVUS code, make sure the base code is on this list.
Without supporting documentation, IVUS codes cannot be assigned.
- IVUS codes are assigned per vessel evaluated – Identify every vessel evaluated by name. It is also important to note that CPT states, “If a lesion extends across the margins of one vessel into another, this should be coded with a single code despite imaging more than one vessel.”
- Only one IVUS code can be assigned per vessel evaluated – Even though IVUS may be needed to evaluate a single vessel before, during, and after an intervention, it can only be coded one time per vessel.
- Proof of medical necessity is required for every code assigned – Because IVUS is adjunct to another procedure such as angiography, there must be documentation supporting medical necessity for each one. Explain why the IVUS was needed in addition to the diagnostic angiogram.
- Include catheter movement – Catheter placement codes need to be assigned when they are not already bundled into the base code. Always document catheter movement. For example, “From a right common femoral vein access, the IVUS catheter was placed into left external iliac vein (36012), IVUS was performed to characterize the stricture and size the vein for subsequent stent placement. The findings were… (37252).”
- IVUS codes are assigned per vessel evaluated but when the abnormality transverses another contiguous vessel, one IVUS code is assigned instead of two
- Modifier 50 cannot be assigned to 37252 and 37253; instead, count these bilateral evaluations as two.
- IVUS codes are add-on codes which mean they can never be assigned/billed without a base code
- Medical necessity and findings must be documented for every vessel evaluated by IVUS
- IVUS cannot be assigned in addition to IVC filter placement, replacement, or retrieval, or intravascular foreign body retrieval
- Catheter placements are not included in the CPT code descriptions for IVUS and are coded/billed separately
- Document catheter movement