2026 Coding Debrief: Lessons, Questions, and Next Steps-LER Cheat Sheet

LER Cheat Sheet

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This document is a comprehensive coding guide for Lower Extremity Revascularization (LER) procedures, detailing vascular territories, relevant CPT codes, and billing guidelines provided by the Society for Cardiovascular Angiography and Interventions (SCAI).

The vascular territories are divided into four main regions with specific CPT codes for initial and additional vessels treated:

1. <strong>Iliac Vascular Territory</strong>  
   - Includes common, internal, and external iliac arteries.  
   - Use initial codes 37254, 37256, 37258, 37260 for first treated vessel.  
   - Up to two add-on codes (37255, 37257, 37259, 37261) for additional vessels per extremity.  
   - Lithotripsy code 37262 can be used up to three times per leg.  
   - Use 0238T for iliac atherectomy.

2. <strong>Femoral/Popliteal Territory</strong>  
   - Includes common femoral, profunda femoris (treated as one vessel), superficial femoral, and popliteal arteries (treated as one vessel).  
   - Initial codes 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277.  
   - One add-on code per extremity from 37264, 37266, 37268, 37270, 37272, 37274, 37276, 37278.  
   - Lithotripsy code 37279 may be used twice per leg.

3. <strong>Tibial/Peroneal Territory</strong>  
   - Includes anterior tibial, posterior tibial, and peroneal arteries; tibioperoneal trunk reported only if sole vessel treated.  
   - Initial codes 37280, 37282, 37284, 37286, 37288, 37290, 37292, 37294.  
   - Up to two add-on codes per extremity from 37281, 37283, 37285, 37287, 37289, 37291, 37293, 37295.

4. <strong>Inframalleolar Territory</strong>  
   - Includes dorsalis pedis and plantar arteries; pedal arch reported only if sole vessel treated.  
   - Initial codes 37296, 37298.  
   - One-add on code per extremity from 37297, 37299.

General Coding Guidance:  
- Use the code for the most complex procedure if more than one lesion is treated.  
- Do not use add-on codes for multiple lesions within the same vessel.  
- Lithotripsy codes have usage limits per leg.  
- Add-on codes permit reporting additional vessels treated beyond the primary.

The document also provides crosswalks linking deleted codes to new codes, definitions of lesion complexity, and detailed descriptors for each CPT code by vascular territory and procedure type (angioplasty, stent placement, atherectomy, combined procedures). It cites 2025 and 2026 AMA CPT resources.

Disclaimer: This guidance reflects expert consensus and is for educational use only; it is not clinical or legal advice. Proper CPT code selection remains subject to individual case specifics and payer rules.

Keywords

Lower Extremity Revascularization

LER coding guide

vascular territories

CPT codes

Society for Cardiovascular Angiography and Interventions

SCAI billing guidelines

iliac vascular territory

femoral popliteal territory

tibial peroneal territory

inframalleolar territory