2026 Coding Debrief: Lessons, Questions, and Next Steps-2026 PCI LER Iliac Brochure

2026 PCI LER Iliac Brochure

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This document summarizes the Society for Cardiovascular Angiography and Interventions (SCAI) guidelines for CPT coding of lower extremity revascularization procedures in the iliac vascular territory. These procedures include endovascular, open, or percutaneous transluminal angioplasty and stent placement, as well as intravascular lithotripsy. Key CPT codes described are:<br /><br />- 37254–37257: Iliac artery revascularization via angioplasty, with codes distinguishing straightforward versus complex lesions and initial versus additional vessels treated.  <br />- 37258–37261: Stent placement codes, again distinguishing lesion complexity and additional vessels.  <br />- 37262: Intravascular lithotripsy, reported as an add-on code and may be reported up to three times per leg.<br /><br />Important coding guidelines include:  <br />- Only one primary code per vascular territory is used, with add-on codes for additional vessels (maximum two add-ons per leg).  <br />- Stent placement codes are reported once per vessel, regardless of number of stents.  <br />- Procedures are reported per vessel, not per lesion.  <br />- Bilateral procedures use modifier 50 on the base code, with add-on codes reported twice.  <br />- Interventions on separate legs are reported independently using modifier 59 if needed.  <br />- Lesions spanning multiple territories treated with one technique should be reported with a single code.  <br />- Iliac atherectomy is reported separately with code 0238T.  <br />- Procedures not crossing lesions should be billed using diagnostic angiography codes.<br /><br />The document clarifies that lower extremity revascularization includes access, selective catheterization, lesion crossing, radiologic supervision, embolic protection, closure of arteriotomy, and imaging for documentation.<br /><br />References cite CPT coding manuals and emphasize that this guidance reflects consensus opinion for proper CPT usage, not legal or clinical advice. The source underscores consulting legal counsel for coding-related decisions specific to individual patient cases.

Keywords

SCAI guidelines

CPT coding

lower extremity revascularization

iliac artery

angioplasty

stent placement

intravascular lithotripsy

vascular territory

modifier 50

code 0238T