Ask Dr. Z

For physician billing, are any additional codes appropriate when a carotid stent is placed using flow reversal? My understanding is that code 37215 includes the work of establishing flow reversal and closure, but some physicians want to bill codes 36556 and 35201 in addition to 37215. Here's an example of the documentation: "Right femoral vein access was gained using micropuncture under ultrasound guidance. An 8 French venous sheath was placed. Next a supraclavicular incision was made over the area of sternocleidomastoid muscle. Common carotid was dissected. Micropuncture was used to access common carotid artery. Silk road sheath was then inserted and secured with 2.0 silk suture. Flow reversal then connected. A 7 x 30 mm silk road carotid stent was then deployed. Postprocedure angiogram showed no residual stenosis. Wires and sheath were removed, and arteriotomy was repaired primarily with 6.0 Prolene stitches. Common carotid was unclamped. Total of 8.5 mins of flow reversal. Wound was irrigated, and hemostasis was controlled. Platysma was closed with 3 0 Vicryl in running fashion."