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Basics about Kissing Stents CPT code

For coding vascular procedure in interventional radiology, a through knowledge about blood vessels is very important. For both upper and lower extremity coding procedures, coder should have a good anatomic knowledge about arteries and veins. Also, the medical coder should follow the coding rules of vascular families while coding selective and non-selective catheterization procedures.

Coming to interventional procedures, we have learnt about angioplasty, stent and atherectomy procedure codes for lower extremity previously. Kissing stent are also placed in the lower extremity arteries in common iliac arteries. The procedures codes for angioplasty, stent and atherectomy includes the selective catheterization exams. If you want to know about vascular procedure coding, you can refer the below posts.

Selective and Non-Selective Catheter Placement of Lower extremity arteries

Coding tips for Revascularization CPT codes (37220-37235) for lower extremity

Selective catheterization tips for CPT code 36251, 36252, 36253 and 36254

Kissing stents are placed in the lower extremity when the patient has stenosis on both common iliac arteries. The name “Kissing Stents” arises because both the stents when placed on iliac arteries, appears kissing to each other (as shown in the below picture).

The physician punctures both femoral arteries and inserts a stent from each side. Both the upper end of the stent extends into the abdominal aorta, so that the patient has two stents side-by-side in the distal abdominal aorta.

The main use of kissing stents is to avoid causing stenosis on the opposite side.

What is the CPT code for kissing stents?

To treat the bilateral iliac artery stenosis, the physician punctures the left common femoral artery and then advances the catheter into the aorta. The physician then performs the aortogram. Then the physician pulls the catheter down to the bifurcation and performs bilateral lower extremity angiogram. Then angiograms reveal bilateral iliac artery stenosis.

Then the physician punctures the right common femoral artery and places the stents in the bilateral common iliac arteries. The stents are deployed in such a way that its upper ends extends into the lower aorta. The above scenario will be reported with below codes.

37221-50 ( for second puncture)

36200- X{EPSU} or 59 (for first puncture)

75625

75716- X{EPSU} or 59

Vascular Coding Practice charts for Coders

Sample coded report for “kissing stents” CPT code

PROCEDURE IN DETAIL: Local anesthetic was infiltrated in the right and the left groin. Using fluoroscopic guidance, a French sheath was placed in the right common femoral artery. A pigtail catheters was placed in the infrarenal aorta, and digital arteriogram of the infrarenal aorta and pelvis was obtained, confirming stenosis in both common iliacs and the left external iliac.

Using fluoroscopic guidance, a sheath was palced in the left common femoral artery. A guidewire was manipulated into the abdominal aorta. An 8 x 37 mm balloon expandable stent was then positioned in each common iliac artery and deployed with kissing balloon technique (37221-50). Pigtail catheter was then placed in the infrarenal abdominal aorta and digital runoff showed good results.

We then evaluated the left external iliac lesion with pressure measurements. There was a 20 mm gradients across this area, so decision was made to place a stent. A 7 x 39 mm self-expanding stent was deployed across the lesion and dilated with a 7 mm balloon (37223). Follow-up angiogram shows good results.

The catheter and sheath were removed from both groins and hemostasis was obtained. The patient at that point had a strong right common femoral pulse and a palpable pulse on the left, although the left is decreased relative to the right.

CONCLUSION;
1. Successful percutaneous transluminal angioplasty and stenting of the each common iliac artery using stent, 8 x 37 mm.

2.Successful percutaneous transluminal angioplasty and stenting of the left external iliac artery using stent, 7 x 39 mm.

CPT code: 37221-50

37223