Scenario 1: Failed Percutaneous Procedure Followed by Open Procedure in the Same Vessel
If a percutaneous vascular procedure is attempted but fails, and is followed by an open procedure in the same vessel during the same encounter, only the open procedure is reported.
Example:
A physician attempts a percutaneous transluminal angioplasty (PTA) on the femoral artery, but it fails. The physician then performs an open femoral thromboendarterectomy during the same encounter.
Reported CPT Code: Only the CPT code for the open thromboendarterectomy is reported.
Scenario 2: Percutaneous Procedure on One Lesion and Open Procedure on a Separate Lesion in Distinct and Separate Anatomically Defined Vessels
If a percutaneous procedure is performed on one lesion and a similar open procedure is performed on a separate lesion in distinct and separate anatomically defined vessels, both procedures may be reported. Modifier 59 (distinct procedural service) or XS (separate structure) should be used with the percutaneous procedure code.
Example:
A physician performs a percutaneous transluminal angioplasty (PTA) on a lesion in the left femoral artery and an open thromboendarterectomy on a lesion in the right femoral artery during the same encounter.
Reported CPT Codes: CPT code for PTA on the left femoral artery with modifier 59 or XS. CPT code for open thromboendarterectomy on the right femoral artery.
Scenario 3: Percutaneous and Open Procedures on Different Lesions in the Same Anatomically Defined Vessel
If both a percutaneous and an open procedure are performed on different lesions within the same anatomically defined vessel, only the more extensive open procedure is reported.
Example:
A physician performs a percutaneous thrombectomy on a lesion in the proximal segment of the left femoral artery and an open thrombectomy on a lesion in the distal segment of the same artery during the same encounter.
Reported CPT Code: Only the CPT code for the open thrombectomy is reported.
Summary of Coding Principles:
Failed Percutaneous Followed by Open in Same Vessel: Report only the open procedure.
Percutaneous and Open in Separate Vessels: Report both procedures using modifiers 59 or XS for the percutaneous procedure.
Percutaneous and Open in Same Vessel: Report only the open procedure.
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