What do the 2026 coding changes mean for the financial viability of IVL in the OBL? In this episode of the BackTable Podcast, host Dr. Ally Baheti sits down with Dr. Nicholas Petruzzi to break down how intravascular lithotripsy fits into OBL workflows, and how upcoming lower-extremity revascularization coding updates may impact outpatient economics.

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This podcast is supported by

Shockwave Medical
https://shockwavemedical.com/

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Timestamps

00:00 - Introduction
02:35 - 2026 Coding Changes Overview
05:18 - Where IVL Codes Apply
06:35 - Iliac Reimbursement Impact
08:50 - IVL vs. Atherectomy
11:54 - BTK Reality and Future
14:44 - When IVL Is Not Ideal
16:05 - Catheters and Setup Basics
17:50 - Sizing and Technique Tips
23:01 - Javelin Forward Emitter
26:25 - Wrap Up

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More about this episode

The episode starts with a walkthrough of the key 2026 coding updates, including territory-based coding, new IVL add-on codes for aorto-iliac and fem-pop segments, the introduction of below-the-ankle codes, and the shift toward ‘simple’ versus ‘complex’ designations. From there, the conversation focuses on where IVL makes sense clinically and operationally, particularly as an alternative or complement to atherectomy, with discussion of low embolization risk seen in the DISRUPT PAD trial and the potential to avoid distal protection in select cases.

Dr. Petruzzi shares how he approaches IVL in the lab, including catheter selection, sizing, low-pressure technique, and repositioning strategies. They also touch on workflow considerations in the OBL and preview newer concepts like the forward-emitting Javelin device for heavily calcified lesions and situations where device exchange is limited.

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Resources

DISRUPT PAD III RCT
https://shockwavemedical.com/en-eu/clinical-evidence/pad-iii-rct/

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BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists.

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