Internalize intravascular lithotripsy HCPCS Level II coding for lower extremities

Shockwave intravascular lithotripsy (IVL) is a relatively new technology used to treat areas of severely calcified coronary arteries. The IVL device uses sonic pressure waves to fracture intimal and medial calcifications on stenotic artery walls. IVL increases vessel wall compliance and luminal gain.

Interventional radiologists and vascular surgeons are two types of providers that perform intravascular lithotripsy of the lower extremities. A physician may recommend this procedure to patients with peripheral artery disease (PAD) who present with calcified lesions that are challenging to treat.

Peripheral arterial calcification is difficult to dilate with balloon angioplasty. With atherectomy, superficial calcified plaque is treated, but medial calcification of the artery is not. The presence of calcium build-up in the artery increases the likelihood of complications such as embolization, recoils, and dissections.

Procedure description 

In the shockwave IVL procedure, shockwaves are delivered close to the calcified lesion, which limits the energy required and the potential for soft tissue injury. Also, the risk to non-calcified portions of the vessel is limited. The calcium is not removed from the arteries but is fractured/remodeled.

A typical IVL of the lower extremities may be performed by placing a balloon catheter across the calcified lesion in the vessel and inflating it to 4 atm (standard atmospheric pressure). Then, the IVL shockwave therapy is performed, which affects superficial and deep calcium build-ups. Prior to deflating the balloon, it is re-inflated to 6atm.

Stenting following balloon angioplasty is commonly required due to early recoil, which is defined as lumen compromise of more than 10%. This causes luminal narrowing and promotes restenosis. Using IVL in place of regular balloon angioplasty can avoid the need for stenting.

There are low rates of complications from IVL; for example, the rate of associated dissection is less than 2 percent. The procedure is similar to extracorporeal shockwave lithotripsy, in which the lithotripter device emits shockwaves from outside the body. IVL shockwaves do not cause tissue damage due to their low tensile strength.

For more on internalize intravascular lithotripsy, read the full article in JustCoding.  

 Jane Arbogast-Schappell, CCS, CPC, CCC, CIRCC