Appeal type: Surgery
Decision: Favorable

 
We decided that the Plan has to pay for revascularization and angioplasty (procedure codes 37220, 37221, and 
75716) provided to the enrollee on March 25, 2022. 
 
You asked the Plan to pay for the services. You say that this should be paid for. The Plan denied your request. 
The Plan says that the records do not support the services billed. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. In this case, the CPT Code Manual definition of 
the denied codes is: 
 
CPT 37220: 
 
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal 
angioplasty 
 
CPT 37221: 
 
Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal 
stent placement(s), includes angioplasty within the same vessel, when performed 
 
CPT 75716: 
 
Angiography, extremity, bilateral, radiological supervision and interpretation 
 
We asked our coder to carefully review the case file and apply the relevant Medicare rules to determine if the 
Plan was correct in denying the request to pay for the services. Our reviewer says that the documentation 
supports the use of the codes in question. Our reviewer found that in terms of CPT 75716, this codes for 
diagnostic angiography bilateral extremities. This code can be billed separately if there was no recent prior 
catheter-based angiogram or if there was a change in condition.  There is no evidence that there was a recent 
prior catheter-based angiogram and the documentation provided includes satisfactory detail of the diagnostic 
angiogram bilaterally to justify use of this code.  
 
In terms of CPT 37220, this codes for iliac percutaneous transluminal angioplasty (PTA). There is satisfactory 
documentation that left common iliac PTA was performed and there is documentation of pre procedure 
findings and result. 
 
In terms of CPT 37221, this codes for iliac artery stenting with or without PTA. There is documentation that a 
dissection of the right external iliac artery was treated with an iliac stent with documentation of pre and post 
intervention findings. While typically only one based code can be used per vascular territory, the iliac stent was 
on the contralateral side and, therefore, a second base code can be used (separate territory). 
 We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
revascularization and angioplasty (procedure codes 37220, 37221, and 75716) provided to the enrollee on 
March 25, 2022.  
 
If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.