Percutaneous Transluminal Balloon Angioplasty (35476/75978)
POLICYDuring this procedure, the physician isolates a vein and inserts a large needle through the skin and into the vein. A guide wire is threaded through the needle into the vessel. The needle is removed. A catheter with a balloon attached follows the venous system and into the narrowed portion of vessel. There, the balloon is inflated. The blood vessel is stretched to a larger diameter, allowing a more normal outflow of blood through the area. Several inflations may be performed to achieve the desired outcome along the narrowed area.
According to CPT coding guidelines, procedure code 35476 should be reported one time for each vessel/vein treated. If the balloon is inflated and deflated several times along the course of a single vessel/vein, the treatment of that vessel/vein is counted only once. However, if four vessels/veins are treated by PTBA, four units are reported. The number of vessels/veins treated should be counted, not the number of dilations or the number of lesions treated.
When radiological supervision and interpretation is performed in conjunction with PTBA, CPT code 75978 is also reported.
POLICY GUIDELINESThe coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
POLICY HISTORY3/2007: Policy developed