Bridging the Gap Between Coding and CV Care: Getting Ahead of the 2026 LER Coding Changes

That is why the 2026 LER coding changes are not only necessary but overdue. These revisions better reflect the complexity of today’s procedures and the work performed by our providers. While any coding transition can feel daunting, this one is ultimately a positive step toward clarity, accuracy and alignment with modern cardiovascular care.

Now is the time for cardiovascular administrators, physicians, advanced practice providers (APPs), care team members, coders and coding managers to begin preparing. The earlier we understand what’s changing and why, the smoother the transition will be for our organizations and the better positioned we’ll be to ensure accurate documentation, compliant reporting, and appropriate reimbursement when the new codes take effect.

In this blog, I want to not only communicate the importance of clear documentation with these new codes, but also give the care team a better understanding of the guidelines and what coders need to properly capture charges. Each member of the care team has a role to play in coding and documentation.  

For 2026 LER procedures, all the interventional codes from 37220-37235 have been deleted. In their place, there are 46 new ones (37254-37299). The interventional codes include angioplasty, stenting, atherectomy, stenting and atherectomy, and intravascular lithotripsy (a new procedure for 2026).

Let’s break this down:

• Whether the providers take an interventional or an open approach in these procedures, interventional codes remain the same.
• Each leg is a vascular family. Within that family are territories – iliacs, femoral/popliteal, tibial/peroneal and inframalleolar, which is new for 2026 and much needed!
• Iliac territory consists of three separate vessels identified as common, external and internal. We can code for the initial vessel treated and up to two additional vessels.
• Femoral/popliteal territory consists of common femoral, superficial femoral (SFA), profunda femoral and popliteal. New for 2026, the codes recognize two separate vessels that can be coded. They are made up of common femoral/profunda as one billable vessel and SFA/popliteal as the second vessel. We can code for the initial vessel and one additional vessel.
• Tibial/peroneal territory consists of three separate vessels: anterior tibial, posterior tibial and peroneal.
  • Note: Tibial/peroneal trunk (TP) is included in the posterior or peroneal artery.
  • We can code initial vessel treated and up to two additional vessels.
• Inframalleloar territory consists of dorsalis pedis and the Plantar.
  • Pedal Arch is included in the dorsalis or the plantar. Note: Only angioplasty is coded in this territory.
  • One initial vessel and one additional.

For 2026 the LER codes keep these documentation points in mind:

Guidelines from the 2026 CPT book do state: “A procedure that does not result in successful crossing of a lesion and successful endovascular intervention is considered a diagnostic procedure and is reported using the appropriate catheterization and diagnostic angiography code(s).” The guidelines give another example: “an unsuccessful attempted crossing of an occluded 16-cm femoral artery lesion from contralateral access would be reported as a diagnostic arteriogram (e.g., 36247, 75710).”¹

Importantly, some of the 2025 guidelines are not changing in 2026:

• Ultrasound guidance is billable, provided there is documentation of vessel patency, real-time visualization of needle entry, and permanent images.
• Catheter placements bundle with the interventions in the lower extremities, unless separate access is obtained to perform diagnostic angiography, or placed in other vascular families (i.e., visceral, upper extremities)
• Diagnostic angiography is billable. provided there has not been a recent study (including CTA). If there has been a recent study, you may be able to bill for another diagnostic study if one or more of these following conditions are met and documented in the operative report:

1. 1. The previous study images are not well visualized, and it’s hard to discern anatomy.
   2. There has been a change in the patient’s condition since the previous study.
   3. There is a change in the patient’s condition during the procedure outside the treatment area.  

• Intravascular ultrasound (IVUS) is separately billable, and there must be findings documented. A pullback IVUS is reported as one IVUS.
• Mechanical thrombectomy is separately reported. It is important that the documentation identify if the thrombus was known and the thrombectomy was planned (considered primary) or if it’s a result of a thrombus breaking off from another intervention that requires it to be retrieved (considered secondary).
• Angioplasty performed for macerating a clot is not separately reported as it is considered part of the thrombectomy.
• When atherectomy/thrombectomy are performed with the same device in the same vessel, only the atherectomy is reported.
• Extensive repair of an artery is separately reported if necessary.
• Except for Iliac atherectomy, all other interventions within one vessel are coded as one intervention.
• Bridging lesions that cross into other vessels or territories but can be treated with one intervention are coded as one intervention. Code for the furthest vessel in this case.
• In addition to what was already in the article, the following are included in interventional procedures: Access, angioplasty when performed with stent, atherectomy etc. in the iliacs, femoral/popliteal and tibial/peroneal arteries. Embolic protection devices and closure devices, stitches. etc., are also included.

The MedAxiom Revenue Cycle Solutions team will be hosting our annual Coding Bootcamp webinar series to cover CPT changes that will affect cardiovascular and cardiothoracic/vascular surgery services in 2026. If you want to learn more about this and other topics, I encourage you to join us from December 15 – 18^th. We equip every member of the care team with the information they need:

2026 CPT Coding and MPFS Final Rule Changes: Impacts to Cardiovascular Services

• Monday, Dec. 15 | 1 - 2:30 p.m. ET
• Audience: Practice administrators, physicians, providers, coding managers and coders

Navigating the New CPT Structure for Lower Extremity Revascularization

• Tuesday, Dec. 16 | 1 - 2:30 p.m. ET
• Audience: Coding managers and coders

Digital Health and AI in 2026: Coding, Compliance and Revenue Opportunities

• Wednesday, Dec.17 | 1 - 2:30 p.m. ET
• Audience: Practice administrators, physicians, providers, coding managers and providers

Coronary PCI in 2026: Navigating the New CPT Codes, Documentation Standards and Reimbursement Impacts

• Thursday, Dec. 18 | 1 - 2:30 p.m. ET
• Audience: Coding managers and coders

READ SESSION DESCRIPTIONS & REGISTER FOR BOOTCAMP

As we move toward the 2026 transition, it’s essential for every member of the cardiovascular care team to understand their individual roles in accurate documentation and coding. When the entire team works from the same foundation of knowledge, we not only ensure compliant reporting and appropriate reimbursement, but also strengthen the quality of care, efficiency, and integrity of the care we deliver to our patients.

Reference:

• American Medical Association (AMA). 2026 AMA CPT® Professional Edition. American Medical Association Press; 2025.
  

Illustration by: Lee Sauer