Billing and Coding: Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities L40228 . The intent of the LCD provisions for office-based surgery centers qualifications and coverage limitations of endovascular revascularization (EVR) services is to regulate performance of those procedures when performed under conscious sedation or higher levels of anesthesia. They are as follows: Provider Qualifications Office-based surgery center that meets state guidelines and, if required by the state, national accreditation standards when performing EVR procedures under conscious sedation or higher levels of anesthesia. For states that allow national accreditation in lieu of state requirements, national accreditation by a recognized accrediting body for office-based surgery, when conscious sedation or higher levels of anesthesia are provided for EVR procedures, would be sufficient for this site of service. Under Limitations for Endovascular Revascularization Performance of an endovascular revascularization in an office setting that has not met their state requirements or, if required by the state, national accreditation standards for EVR procedures when conscious sedation or higher levels of anesthesia are utilized. Documentation Requirements: The presence or absence of the following should be documented in the medical record: Decision-making for endovascular revascularization — A decision for endovascular versus open surgical revascularization should be individualized and oriented to patient-centered goals. The availability of autologous vein as a bypass conduit (preferably >3 mm single-segment great, if required, should be part of the decision-making process). Coronary artery disease – Symptomatic or asymptomatic Chronic obstructive pulmonary disease (COPD) – Oxygen dependence Renal function – Chronic kidney disease, dialysis Diabetes – Insulin dependence, HbA1c level Functional capacity – Unimpaired, impaired but can perform activities of daily living (ADLs) without assistance, needs assistance with ADLs or ambulation, needs full assistance for ADLs, dependent Ambulatory status – Non-ambulatory, transfers only, ambulatory Frailty Living situation – At home, nursing home, or in transition Nutritional status Previous revascularization procedures and other interventions Perioperative morbidity and mortality risk and the specific goals for the revascularization all have a significant impact on choosing between an endovascular, open, or hybrid (combined endovascular/open) revascularization procedure. The need for imaging (should not be performed before the clinical decision is made to intervene; anatomic complexity does not determine the need to intervene.) Anatomically less-complex lesions are typically treated using an endovascular approach in patients being treated for claudication or CLTI; however, for patients with more complex anatomy, whether to pursue endovascular intervention rather than lower extremity bypass surgery becomes more difficult and the face-to-face encounter should document the rationale for the endovascular approach over surgical revascularization. Place of Service (POS) Codes: -11, -21, -22 and -24.