Endovascular Revascularization
1. Open
2. Percutaneous
3. Transcatheter
CPT 37220 – 37235 Lower extremity endovascular revascularization services performed for occlusive disease.
These codes are built on progressive hierarchies with more intensive services inclusive of lesser intensive services. The code inclusive of all of the services provided for that vessel should be reported.
Only one code should be reported for each lower extremity vessel treated.
Included services,
· Access point
· Selectively catheterizing the vessel
· Traversing the lesion
· Radiological supervision and interpretation related to intervention
· Embolic protection if used
· Closure of the arteriotomy by pressure and application of an arterial closure device or standard closure of the puncture by suture.
· Imaging
· Each code (37220-37235) includes balloon angiography
Extensive repair or replacement of an artery may be additionally reported (35226 or 35286).
Vascular territories
1. Iliac – Divided into 3 vessels
A. Common iliac
B. Internal iliac and
C. External iliac
2. Femoral/Popliteal – Considered as a single vessel in one lower extremity
3. Tibial/Peroneal - Divided into 3 vessels
A. Anterior tibial
B. Posterior tibial
C. Peroneal arteries
If multiple vessels within the same territory are treated report single base code followed by add-on codes for each additional vessel.
Select the base code that represents the most complex service using the following hierarchy of complexity
Angioplasty < Stent < Atherectomy < Atherectomy and stent
Coding Guidelines:
1. Iliac Vascular Territory
A single primary code is used for the initial iliac artery treated in each leg – 37220 or 37221
If other iliac branch vessels are also treated in that leg, add-on code 37222, 37223
· Maximum 2 add-on codes can be used in a unilateral iliac vascular territory since there are 3 vessels which could be treated.
· Add-on codes are used to different vessels, not for distinct lesions within the same vessel.
2. Femoral/Popliteal Territory
A single code is used since there is no add-on code for additional vessels treated within the femoral/popliteal territory.
CPT codes 37224, 37225, 37226 or 37227
Eg: If 2 lesions are treated in this territory report the most complex procedure, eg: Stent is placed for 1 lesion and an Atherectomy is performed on a second lesion – Code 37227
3. Tibial / Peroneal Territory
A single primary code is used for the Tibial / Peroneal artery treated in each add-on 37228, 37229, 37230 or 37231
If other Tibial / Peroneal vessels are also treated in that leg, use add-on code 37232 - 37235
· Maximum 2 add-on codes can be used in a unilateral Tibial / Peroneal vascular territory since there are 3 vessels which could be treated.
· Add-on codes are used to different vessels, not for distinct lesions within the same vessel.
· The common tibio-peroneal truck is considered part of the Tibial / Peroneal Territory
Eg: Lesion in the common tibio-peroneal trunk is treated in conjunction with lesions in the posterior tibial artery – A single code would be reported for treatment of this segment.
General Guidelines:
A. If multiple territories in the same leg are treated, use one primary code from each territory treated. For additional vessels, respective Add-on codes are used.
Eg: One stent placed in external iliac and one stent placed in a femoral artery.
37221, 37226
Note: If more than one stent is placed in the same vessel- code only once.
B. If a lesion extends across the margins of one vessel vascular territory into another but can be opened with a single therapy – Should be reported with a single code.
Eg: Stenosis extends from the common iliac artery into the proximal external iliac artery and a single stent is placed to open the entire lesion
– Use only 37221 (Don’t code 37221 and 37223)
C. For bifurcation lesions to the common iliac origins which require therapy of 2 distinct branches of the iliac or tibial/peroneal vascular territories – A primary code and add-on code would be used.
Exception for femoral/popliteal territory – all the branches are included in the primary code, so for bifurcation lesions would be reported as a single code.
The same territory of Bilateral legs – append 59 modifier
D. Mechanical Thrombectomy and/or thrombolysis in the lower extremity vessels are reported separately.
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Balloon Angioplasty other than lower extremity
Balloon angioplasty is utilized to improve the blood flow through a blocked or narrowed vessel (Arteries or Veins).
Coding balloon angioplasty depends on
· Technique (Open or percutaneous)
· Location
· Number of vessels treated
CPT 37246, 37247 - Artery (Open or percutaneous)
CPT 37248, 37249 – Vein (Open or percutaneous)
The above codes include the following services,
· Radiological supervision and interpretation
· Imaging
Coding Guidelines:
Multiple angioplasties performed in a single vessel - Use single code.
The lesion extends across the margins of one vessel into another but can be treated with a single therapy – Use a single code
IF additional separate and distinct ipsilateral or contralateral vessels are treated in the same session – Use 37247 or 37249 (add-on codes)
Transluminal intravascular stent insertion other than lower extremity
CPT 37236, 37237 – Transluminal intravascular stent insertion in an artery
CPT 37238, 37239 - Transluminal intravascular stent insertion in a vein
Coding Guidelines:
Multiple stents placed in a single vessel – Use a single code
The lesion extends across the margins of one vessel into another but can be treated with a single therapy – Use a single code
If additional separate and distinct ipsilateral or contralateral vessels are treated in the same session – Use 37237 or 37239 (add-on codes)