Q&A: Documentation and CPT coding for percutaneous femoral popliteal revascularization

Q: How do you know when Category III CPT code 0505T is the appropriate code to assign for a femoral popliteal revascularization?

A: This 2019 code describes a surgical alternative to bypass surgery. Per the CPT Manual, 0505T is used to report an endovenous femoral-popliteal arterial revascularization using percutaneous or open vascular access, ultrasound, or fluoroscopic guidance for catheterization.

The code description includes transcatheter placement of intravascular stent grafts and closure by any method, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention, including all associated radiological supervision and interpretation, with crossing of the occlusive lesion in an extraluminal fashion.

An endovenous femoral-popliteal arterial catheterization with transcatheter placement of intravascular stent grafts may be performed when a patient has lower limb occlusion causing ischemia due to atherosclerosis or other peripheral vascular diseases (PVD) causing impaired blood flow to legs and feet.

Symptoms of PVD include leg pain and numbness, non-healing wounds, infection, and gangrene. The common femoral arteries are large vessels that run anteriorly from the groin down each leg. They become the popliteal arteries when they course deeper into the joint capsule of the knee and finally branch into the anterior and posterior tibial arteries. 

During this procedure, the physician gains access into both the arterial system and the venous system at the same time. He or she places multiple overlapping stent grafts that are deployed from the popliteal artery down to the distal anastomosis, into the popliteal vein, and up through the femoral vein.

What differentiates this procedure from traditional bypass procedures is that the physician performs the surgery percutaneously, using stent grafts instead of harvesting a vessel and connecting it above and below the area of occlusion.

Editor’s note: Stacie L. Buck, RHIA, CCS-P, CIRCC, RCC, president and senior consultant for RadRx of Stuart, Florida, and author of Cracking the IR Code: Your Comprehensive Guide for Mastering Interventional Radiology, answered this question during the HCPro webinar, Strategies for Successful CPT Coding of Lower-Extremity Interventional Radiology.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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