2026 Lower Extremity Revascularization Codes for Interventional Cardiology, Part 2-2026 Lower Extremity Revascularization Codes for Interventional Cardiology, Part 2

Video Transcription

Video Summary

This webinar is the second part in a series discussing the 2026 CPT code changes for lower extremity revascularization in interventional cardiology, focusing on tibial peroneal and inframalleolar vascular territories. Historically, CMS deleted 16 old codes and introduced 46 new ones, aiming for more precise coding that differentiates between straightforward (stenosis) and complex (total occlusion) lesions. The new coding structure separates vessels into four territories with distinct base and add-on codes, allowing coding by vessel treated rather than lesion.<br /><br />Monica Wright explained the new code structure: for the tibial peroneal territory (anterior tibial, posterior tibial, peroneal arteries), there are codes for different interventions (angioplasty, stenting, atherectomy, combinations), each divided into straightforward or complex. Add-on codes cover treatment of additional vessels within the territory. Inframalleolar territory covers dorsalis pedis and plantar arteries, with simpler codes covering angioplasty only. Documentation must be precise, listing treated vessels and lesion types, as billing depends on accurate clinical detail to avoid denials.<br /><br />Dr. Jay Geary reviewed a typical clinical case of complex occlusion in the tibial peroneal segment, emphasizing the importance of correct code selection based on intervention type and lesion complexity. He noted the coding system’s grouping of straightforward versus complex lesions strictly by occlusion presence. He also highlighted differences in facility payments by site and complexity, noting outpatient hospital payments are bundled and less affected by coding nuances.<br /><br />Dr. Osama Ibrahim focused on inframalleolar coding, stressing importance of stringent documentation, appropriate clinical indications (only tissue loss or rest pain, not claudication), and caution due to vessel fragility and newness of these codes. He advised collaboration with wound care and podiatry teams and warned against misuse which could trigger audits. He clarified coding guidance around pedal arch interventions, which must be attributed to dorsalis pedis or plantar arteries with careful documentation.<br /><br />The panel discussed challenges with interpretation, payer acceptance, and the need for careful documentation to support coding choices. They underscored the complex transition period as payers adopt new codes and urged practitioners to work closely with billers to avoid denials and prior authorization issues. Additional webinars and resources are planned to address ongoing questions. Overall, the new 2026 codes provide finer granularity and potentially better reimbursement aligned with procedure complexity but require careful adaptation in clinical documentation and coding practices.

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Keywords

2026 CPT code changes

lower extremity revascularization

interventional cardiology

tibial peroneal territory

inframalleolar vascular territory

angioplasty coding

complex vs straightforward lesions

clinical documentation

billing and reimbursement

coding challenges