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

DA60247

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DA60247
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Billing and Coding: Endovascular Management for Peripheral Arterial Disease of the Upper and Lower Extremities
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Billing and Coding
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Article Guidance

Article Text

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 DL40228.

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

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Coding Information

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Group 1

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(46 Codes)
Group 1 Paragraph

Peripheral Arterial Disease (PAD) of Upper Extremities

Group 1 Codes
Code Description
I70.208 Unspecified atherosclerosis of native arteries of extremities, other extremity
I70.218 Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.268 Atherosclerosis of native arteries of extremities with gangrene, other extremity
I70.298 Other atherosclerosis of native arteries of extremities, other extremity
I70.308 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity
I70.318 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.328 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, other extremity
I70.35 Atherosclerosis of unspecified type of bypass graft(s) of other extremity with ulceration
I70.368 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, other extremity
I70.398 Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity
I70.408 Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity
I70.418 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.428 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, other extremity
I70.45 Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration
I70.468 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, other extremity
I70.498 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity
I70.508 Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity
I70.518 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.528 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, other extremity
I70.568 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, other extremity
I70.598 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity
I70.608 Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, other extremity
I70.618 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.628 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, other extremity
I70.65 Atherosclerosis of nonbiological bypass graft(s) of other extremity with ulceration
I70.668 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, other extremity
I70.698 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, other extremity
I70.708 Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, other extremity
I70.718 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, other extremity
I70.728 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity
I70.75 Atherosclerosis of other type of bypass graft(s) of other extremity with ulceration
I70.768 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, other extremity
I70.798 Other atherosclerosis of other type of bypass graft(s) of the extremities, other extremity
I70.8 Atherosclerosis of other arteries
I70.90 Unspecified atherosclerosis
I70.91 Generalized atherosclerosis
I70.92 Chronic total occlusion of artery of the extremities
I73.9 Peripheral vascular disease, unspecified
I74.2 Embolism and thrombosis of arteries of the upper extremities
I74.8 Embolism and thrombosis of other arteries
I75.011 Atheroembolism of right upper extremity
I75.012 Atheroembolism of left upper extremity
I75.013 Atheroembolism of bilateral upper extremities
I76 Septic arterial embolism

Group 2

(173 Codes)
Group 2 Paragraph

PAD of Lower Extremities

Group 2 Codes
Code Description
I70.201 Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
I70.211 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212 Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222 Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223 Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232 Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233 Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234 Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235 Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238 Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241 Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242 Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243 Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244 Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245 Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248 Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.261 Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262 Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263 Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291 Other atherosclerosis of native arteries of extremities, right leg
I70.292 Other atherosclerosis of native arteries of extremities, left leg
I70.293 Other atherosclerosis of native arteries of extremities, bilateral legs
I70.301 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg
I70.302 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg
I70.303 Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs
I70.311 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.321 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg
I70.322 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg
I70.323 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.331 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh
I70.332 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf
I70.333 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle
I70.334 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.335 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.338 Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.341 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh
I70.342 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of calf
I70.343 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle
I70.344 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.345 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.348 Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.361 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg
I70.362 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, left leg
I70.363 Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.391 Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg
I70.392 Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg
I70.393 Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs
I70.401 Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.402 Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.403 Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.411 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.438 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.441 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.448 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.461 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493 Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.501 Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.502 Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.503 Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.511 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.538 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.541 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.548 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.561 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.601 Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.602 Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.603 Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.611 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613 Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623 Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.638 Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.641 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.648 Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.661 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663 Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693 Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.701 Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.702 Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.703 Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I70.711 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713 Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723 Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.738 Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.741 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.748 Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.761 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763 Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791 Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792 Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793 Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I70.8 Atherosclerosis of other arteries
I70.90 Unspecified atherosclerosis
I70.91 Generalized atherosclerosis
I70.92 Chronic total occlusion of artery of the extremities
I73.9 Peripheral vascular disease, unspecified
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I75.021 Atheroembolism of right lower extremity
I75.022 Atheroembolism of left lower extremity
I75.023 Atheroembolism of bilateral lower extremities
I76 Septic arterial embolism
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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20.7 - Percutaneous Transluminal Angioplasty (PTA)
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Keywords

  • Peripheral Arterial Disease
  • PAD
  • Upper Extremity
  • Lower Extremity
  • Endovascular