The 2026 Vascular Fluency Test: Six Questions, Answer Key Included

Here is a six-question fluency test that distinguishes the two, with the answer key printed under each question. That's deliberate. These aren't matters of opinion or "it depends"; they're checkable facts from the 2026 framework, which means you don't need coding expertise to grade the test. All you're really grading is speed and confidence.

And fair warning, freely given: this test works in every direction. Point it at us too. We publish the answers because a biller who has to look them up has already told you something.

1. "What makes a lesion 'complex' under the new framework?"

The right answer is immediate and specific: total occlusion (100%), while a stenosis of any severity is straightforward. If the answer involves hedging about "complicated cases" or "physician judgment," the person managing your highest-value distinction doesn't know where the line is.

2. "When can we bill diagnostic angiography with an intervention?"

Fluent answer: when no prior catheter-based study exists and the decision to intervene is based on this one, or when a prior study exists but the record documents a changed condition, inadequate visualization, or a new clinical question arising outside the target area during the procedure. A biller who says "we always bill it" is painting an audit target on your practice. One who says "we never do anymore" is quietly donating legitimate revenue to your payers.

3. "Where is lithotripsy separately billable, and where is it bundled?"

Add-on in the iliac and femoral-popliteal territories; bundled, not billable, in the tibial-peroneal territory; and inframalleolar, only angioplasty is reported at all. Bonus follow-up: "What code do you use for iliac atherectomy?" The answer is 0238T, a Category III code outside the new family. Anyone who reaches for the new codes just failed a question your payers grade automatically.

4. "How do you handle a case where the lesion couldn't be crossed?"

The 2026 guidelines convert an unsuccessful crossing into a diagnostic procedure: catheterization plus diagnostic angiography codes. A fluent biller describes rebuilding the claim that way and flagging the documentation needed to support it. A non-answer here means your failed crossings are being billed wrong in one direction or the other: compliance risk or forfeited revenue.

5. "How many documentation queries did you send our physicians last quarter?"

This is the question that exposes the whole relationship. The 2026 framework moved the money into the note: lesion characterization, named anatomy, angiography justification. A billing partner engaged with that reality is regularly going back to physicians with specific gaps *before* submission. If the honest answer is zero, your biller is coding whatever arrives and letting the payer be your quality control. Payers charge for that service in denials.

6. "What's our LER denial rate since January, and what's driving it?"

They have this data. Whether they've analyzed it, and whether they volunteer it comfortably, tells you if your denial report is a management tool or a landfill.

Scoring the test

Crisp answers to all six, without the sound of typing in the background: you have a genuine vascular billing partner, and this exercise cost you a phone call. Fumbles on two or more (especially questions 1, 3, and 4, which have single correct answers printed above) mean your claims are being handled by generalists in a specialty that stopped forgiving generalists in January.

There's an easy way to check their answers against reality. MD Billing's free revenue cycle assessment audits a sample of your actual 2026 vascular claims against the full framework and shows you exactly what's been slipping through: downcoding, missed diagnostic revenue, bundling errors, audit exposure. It's free, it's specific to your data, and it will make your next conversation with your current biller considerably more interesting. Start at mdbilling.com, or contact us directly.

Six questions. One phone call. Your vascular revenue deserves a biller who doesn't need to look up the answers.