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The CPT® Code 37216 refers to the transcatheter placement of intravascular stent(s) specifically in the cervical carotid artery. This procedure can be performed using either an open or percutaneous approach, which involves the insertion of a stent to treat stenosis, or narrowing, of the artery. The procedure includes angioplasty if it is performed, as well as the necessary radiological supervision and interpretation. Notably, this code is utilized when the procedure is conducted without the use of distal embolic protection, which is a device designed to prevent debris from traveling downstream during the stenting process. The cervical carotid artery is a critical vessel that supplies blood to the brain, and addressing stenosis in this area is essential to prevent complications such as stroke. The procedure involves a series of steps that include catheterization, angiography, and the careful placement of the stent to ensure proper blood flow restoration while minimizing risks associated with the intervention.
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The transcatheter placement of intravascular stent(s) in the cervical carotid artery is indicated for the treatment of significant stenosis, which may lead to reduced blood flow to the brain and increase the risk of cerebrovascular events such as stroke. The procedure is typically performed in patients who exhibit symptoms related to carotid artery disease or have imaging studies that demonstrate critical narrowing of the artery. It is particularly relevant for individuals with severe arteriosclerotic disease affecting the cervical carotid artery, which may necessitate intervention to restore adequate blood flow.
The procedure begins with the selection of either a percutaneous or open approach based on the patient's condition. In the percutaneous approach, the femoral or another artery is punctured, and an introducer sheath is inserted to facilitate access. A guidewire is then introduced and advanced into the aortic arch, followed by the advancement of a carotid configuration catheter over the guidewire into the aortic arch. Roadmapping angiograms are obtained to visualize the common carotid artery, after which the guidewire is removed and a hydrophilic wire is introduced. The carotid configuration catheter is then inserted over the hydrophilic wire and maneuvered to conform to the patient's anatomy, allowing it to be advanced into the common carotid artery.
In cases where an open approach is preferred, the introducer sheath is inserted through a surgically exposed common carotid artery via a small skin incision. This approach is particularly beneficial for patients with severe arteriosclerotic disease affecting the femoral or iliac arteries or the aorta. Similar to the percutaneous method, roadmapping angiography is performed on the cervical carotid artery, and measurements of the artery and area of stenosis are taken. The hydrophilic wire is then advanced into the external carotid artery, and the carotid catheter is advanced over this wire. After removing the hydrophilic wire, a stiff wire is advanced to the site of the stenosis, followed by the advancement of a long guiding sheath over the carotid catheter and stiff wire. The carotid catheter and stiff wire are subsequently removed, leaving the long guiding sheath in place.
Once the guiding sheath is in position, the deployment device is advanced across the lesion and positioned in the extracranial aspect of the internal carotid artery. If angioplasty is indicated, a balloon catheter is advanced to the site of the lesion and inflated to dilate the area of stenosis. Following this, the balloon catheter is removed, and the stent delivery catheter is advanced to the lesion site and carefully positioned. The stent is deployed, and the delivery catheter is removed. A balloon catheter may be reintroduced and inflated to ensure the stent is properly seated. Finally, all catheters are removed, and pressure is applied to the venous access site to control any bleeding.
After the completion of the procedure, patients are typically monitored for any complications, including bleeding at the access site or neurological deficits. Post-procedure care may involve the administration of antiplatelet medications to prevent thromboembolic events. Patients are advised to follow up with their healthcare provider for imaging studies to assess the patency of the stent and the condition of the carotid artery. Recovery time may vary based on the approach used, with percutaneous methods generally allowing for quicker recovery compared to open surgical techniques. It is essential for patients to adhere to prescribed follow-up appointments and lifestyle modifications to optimize outcomes and reduce the risk of future cardiovascular events.
| Short Descr | TRANSCATH STENT CCA W/O EPS | Medium Descr | TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ | Long Descr | Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; without distal embolic protection | Status Code | Non-Covered Service | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 0 | CCS Clinical Classification | 59 - Other OR procedures on vessels of head and neck |
This is a primary code that can be used with these additional add-on codes.
| 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2015-01-01 | Changed | Description Changed |
| 2013-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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