Ask Dr. Z

Dr. Z, My question concerns placement of a carotid stent via an open approach. I do not think we can use 37215 because it states "percutaneous" in the code description. Here is his dictation: An oblique incision at the lower neck level, I dissected out the common carotid artery and isolated with a vessel loop towards the cranial end. I then placed a 7-French sheath over a wire and performed diagnostic imaging demonstrating the stenosis and then crossed it primarily stenting with a 7 x 22 iCAST covered stents. We then postdilated to 8 mm and then removed the sheath and balloon and opened the arteriotomy a little bit wider so that we can get good antegrade flushing of the artery. The performing physician did dictate an addendum (to document distal protection, he said): The common carotid artery had been clamped cephalad of the entry site for placement of the sheath. After deploying the stent, the artery was flushed aggressively in order to remove all debris prior to closing the arteriotomy and then restoring flow antegrade to the brain. I cannot find a CPT code for an open placement of a carotid stent. Am I missing it or should this be an unlisted procedure code? I have tried to contact his office coder to see how it was submitted from his office, but I haven't had any success to date. Thanks, Chris McCoy