2026 Coding Debrief: Lessons, Questions, and Next Steps-Slides: Dr. Osama Ibrahim

Slides: Dr. Osama Ibrahim

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This document by Dr. Osama A. Ibrahim summarizes recent CPT (Current Procedural Terminology) code changes for Lower Extremity Revascularization (LER) procedures, highlighting code updates, RVU (Relative Value Unit) modifications, and provides a comprehensive case example demonstrating application of the new codes.<br /><br />Key CPT code changes reflect replacements of older codes with new ones differentiating between straightforward and complex procedures, generally with revised RVUs to align with procedure complexity and resources. Examples include iliac angioplasty and stenting, femoral-popliteal angioplasty, atherectomy and stenting, tibial/peroneal angioplasty, and the introduction of codes for intravascular lithotripsy (shockwave therapy), a newer technique not previously coded.<br /><br />Notable highlights:<br /><br />- Iliac interventions: Codes 37220-37223 replaced with pairs like 37254/37256 for straightforward/complex PTA, with RVUs adjusted (e.g., 7.90 to 7.30/10.75).<br />- Femoral-popliteal interventions: New codes introduced for angioplasty, atherectomy, stenting, and combinations, with separate codes for additional vessels.<br />- Tibial/peroneal and inframalleolar procedures similarly subdivided into straightforward/complex codes, with new codes like 37279 assigned for lithotripsy.<br />- Lithotripsy (intravascular shockwave) now has specific CPT codes (37279), acknowledging its growing therapeutic role.<br /><br />The case example of an 83-year-old patient with critical limb-threatening ischemia illustrates practical coding application for complex multi-level disease treated with combination therapies including lithotripsy, PTA, stenting, and drug-coated balloons. Detailed angiographic findings and procedural plans are mapped to corresponding new CPT codes, demonstrating coding for iliac, femoral-popliteal, tibial/peroneal, and inframalleolar segments.<br /><br />Overall, these CPT changes aim to better capture procedure complexity, improve billing accuracy, and accommodate advances like lithotripsy in the endovascular treatment of peripheral artery disease.

Keywords

CPT code changes

Lower Extremity Revascularization

LER procedures

iliac angioplasty

femoral-popliteal angioplasty

atherectomy

calcium

laser

orbital

plaque

tibial/peroneal angioplasty

intravascular lithotripsy

RVU modifications

peripheral artery disease