Coding Resource Center
Stenting of Popliteal Aneurysm Question: What would the appropriate CPT® code for stenting of a popliteal aneurysm? Answer: Per Clinical Examples in Radiology Spring 2016, code 37236 (Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and […]
Covered Graft Question: What is the difference between a covered graft and an endoprosthesis? Answer: From a coding perspective, there is no difference. CPT® guidelines specify the terms endovascular graft, endoprosthesis, endograft and stentgraft all refer to a covered graft. Drug-coated vs Drug-eluting Question: What is the difference between a drug-coated stent and a drug-eluting […]
Duplex Scans Question: Duplex scans can be used to determine the patency of vessels for hemodialysis access. What CPT® codes are used and how are they distinguishable? Answer: Generally speaking, the extremity duplex scan codes used for hemodialysis access vessel patency are based on whether arteries, veins or both are imaged. For both arterial inflow […]
MODIFIERS: 22 – Increased Procedural Service Question: What are the documentation requirements for reporting modifier 22 (Increased Procedural Services) with procedure codes? Answer: According to CPT® Assistant May 2020, the documentation must support “the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient’s […]
Code Selection Criteria Question: What criteria will be used to select the appropriate evaluation and management (E/M) office or other outpatient code level starting in 2021? Answer: One of the most significant changes for reporting E/M services in 2021 is the use of either time or medical decision making (MDM) as the criteria for total […]
July 2023
On July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Physician Fee Schedule (MFPS). These proposed rules cover physician services furnished to beneficiaries on or after January 1, 2024. Highlights are described below: The complete MPFS proposed rule summary can be found on the GORE Coding Resource […]
On July 17, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC) Prospective Payment System. These proposed rules cover outpatient hospital and ASC services furnished to beneficiaries on or after January 1, 2024. Highlights are described below. […]
On June 27, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Program; Transitional Coverage for Emerging Technologies (TCET). CMS is proposing to provide transitional coverage for emerging technologies (TCET) through the national coverage determination (NCD) process. This pathway is intended to provide more transparency, predictability, and expedited […]
On June 26, 2026, The Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for Calendar Year (CY) 2024. These proposed rules cover renal dialysis services furnished to beneficiaries on or after January 1, 2024. Highlights are described below: The complete […]
June 2023
Gore and Associates announced the first U.S. patient has been enrolled in a prospective, non-randomized, multicenter, single-arm, pivotal study to evaluate the VIAFORT vascular stent for the treatment of symptomatic iliofemoral venous obstruction. This device utilizes the Gore expanded polytetrafluoroethylene (ePTFE) technology with a single wire, sinusoidal-wound nitinol frame. The GORE® VIAFORT Vascular Stent Iliofemoral […]
