Ask Dr. Z

Hi Dr. Z. I saw the errata regarding the tibio-peroneal trunk for vascular interventions: CODING INSTRUCTIONS 18. The tibial/peroneal territory includes three vessels that are separately coded: the anterior tibial, posterior tibial, and peroneal arteries. The tibial/peroneal trunk is considered part of any distal vessel intervention in the posterior tibial and peroneal arteries (similar to the left main coronary artery). The tibial/peroneal trunk is considered a separate vessel from the anterior tibial artery. The dorsalis pedis is considered part of the anterior tibial artery, and the medial malleolar artery is considered part of the posterior tibial artery. However, the SIR 2011 updates state this: 3 Tibial/peroneal territory: subdivided into anterior tibial, posterior tibial and peroneal a 37228–37235 b Report the initial vessel treated as the primary code for the highest level of service provided within the tibial-peroneal territory with addon codes for additional vessels treated (not additional lesions or procedures in the same vessel) c The tibioperoneal trunk is not considered a separate vessel So now I am confused. The CPT books says: “The common tibio-peroneal trunk is considered part of the tibial/peroneal territory but is not considered a separate, fourth segment of vessel in the tibio-peroneal family for CPT reporting of endovascular lower extremity interventions. For instance, if lesions in the common tibio-peroneal trunk are treated in conjunction with lesion sin the posterior tibial artery, a single code would be reported for treatment of this segment.” Is this where you are getting the information in your errata....and counting the tibioperoneal trunk lesion as a separate vessel from an anterior tibial vessel lesion? I just want to be sure where it came from as my staff are going to want to know given the SIR advice. Thanks again. I know if anyone has the answer it is going to be you!