Peripheral Angioplasty and Stenting (Iliac / Femoral / Tibial)

1. Document the access site hemostasis method. Arteriotomy closure devices (Angioseal, Perclose) require specific documentation of device use and that hemostasis was confirmed before the patient left the table. Manual compression should note duration and that pulses were rechecked.
2. Record runoff vessel status on completion angiography. Number of tibial vessels with runoff to the foot is a key quality metric and affects prognosis. Single-vessel runoff carries higher amputation risk and should be documented.
3. For stent placement, document stent type (self-expanding vs. balloon-expandable), size (diameter × length), and final position. Self-expanding nitinol stents are standard for femoropopliteal disease; balloon-expandable stents are preferred for ostial common iliac lesions where precision deployment is required. For non-ostial external iliac and longer iliac lesions, self-expanding stents demonstrate superior outcomes (ICE trial, JACC CI 2017).
4. Extremity atherosclerosis is coded by severity (claudication, rest pain, ulceration, gangrene), side, and ulcer site, and chronic total occlusion is coded as an additional diagnosis. Document each element.

1. Primary service: Report Peripheral Angioplasty and Stenting (Iliac / Femoral / Tibial) as the primary service when it is the definitive operation performed.
2. The 2026 lower extremity revascularization (LER) codes are organized by vascular territory (iliac, femoropopliteal, tibial/peroneal) and tiered by angioplasty vs. stent and straightforward vs. complex lesion. Each territory has standalone primary codes (0-day global) for the first vessel and true add-on codes (ZZZ global) for each additional vessel.
3. Straightforward vs complex: straightforward = any lesion with residual luminal patency (stenosis, even severe), complex = total occlusion (100%, no flow). In-stent restenosis is NOT automatically complex, so classify it by whether it is a stenosis (straightforward) or an occlusion (complex). Add-on codes for each additional vessel in the same territory follow the same tiers and carry a ZZZ global that follows the primary code.
4. Bilateral iliac interventions: for Medicare, report on a single line with the bilateral modifier, and reimbursement is 150% of the unilateral fee schedule amount. Do NOT use right/left laterality modifiers on two separate lines for Medicare, since that format applies to some commercial payers only. Verify payer policy before submitting.
5. Selective catheterization is bundled into the 2026 LER primary codes when used to access and cross the treated vessel, because catheter access to the treated artery is part of the intervention. Separate selective catheterization is reportable only for diagnostic catheterization of territories that are not intervened on at the same session.
6. Diagnostic lower-extremity arteriography is bundled into the LER codes when performed as routine roadmap angiography. It is separately reportable with the distinct-procedure modifier only when no prior catheter-based study is available, a complete diagnostic arteriogram is performed before the intervention decision, and the decision to intervene is based on that study. Document all three elements to support separate billing.
7. Because LER primary codes carry a 0-day global, follow-up duplex surveillance, ABI checks, and subsequent interventions at different sessions are separately billable.
8. Document vessel(s) treated with laterality, lesion characteristics (straightforward stenosis vs total occlusion, lesion length in cm), catheter access site, devices deployed (stent type, size, length), and clinical response. Straightforward vs complex designation determines the code tier and must be explicitly documented, and 'occlusion' must appear in the note to support a complex code.

ⓘ General Documentation & Reimbursement Considerations →