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The CPT® Code 37218 refers to the transcatheter placement of intravascular stent(s) specifically within the intrathoracic common carotid artery or the innominate artery, which is also known as the brachiocephalic trunk. This procedure can be performed using either an open or a percutaneous antegrade approach. The term "transcatheter" indicates that the procedure is conducted through a catheter, which is a thin, flexible tube used to access the vascular system. The common carotid artery is a major blood vessel that supplies oxygenated blood to the head and neck, while the innominate artery branches off from the aortic arch to supply blood to the right arm, head, and neck. During the procedure, the clinician may perform angioplasty, which involves the use of a balloon to widen narrowed or obstructed blood vessels, in conjunction with the stent placement. Radiological supervision and interpretation are integral components of this procedure, ensuring that the placement of the stent is accurately guided and monitored through imaging techniques. The approach to access the femoral vein is critical, as it serves as the entry point for the catheter system. The procedure aims to alleviate stenosis, or narrowing, in these vital arteries, thereby improving blood flow and reducing the risk of complications associated with vascular occlusion.
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The transcatheter placement of intravascular stent(s) using CPT® Code 37218 is indicated for patients who present with significant stenosis or occlusion in the intrathoracic common carotid artery or innominate artery. This procedure is typically performed to restore adequate blood flow to the head, neck, and right arm, which may be compromised due to atherosclerosis or other vascular diseases. The following conditions may warrant this intervention:
The procedure for the transcatheter placement of intravascular stent(s) involves several critical steps to ensure successful intervention. Initially, the clinician selects either an open or percutaneous antegrade approach to access the femoral vein. In the open technique, an incision is made in the skin, and the fascia is separated to expose the femoral vein, which is then incised to allow for the introduction of a catheter sheath. Conversely, in the percutaneous method, a needle is used to puncture the femoral vein, followed by the insertion of an introducer sheath.
Post-procedure care following the transcatheter placement of intravascular stent(s) is essential for ensuring patient safety and recovery. The femoral access site must be closely monitored for any signs of bleeding or hematoma formation. Patients may be advised to remain on bed rest for a specified period to minimize the risk of complications. Follow-up imaging may be required to assess the success of the stent placement and the patency of the artery. Additionally, patients may be prescribed antiplatelet therapy to prevent thrombus formation on the stent and reduce the risk of future vascular events. Clinicians should provide clear instructions regarding activity restrictions and signs of potential complications that warrant immediate medical attention.
| Short Descr | STENT PLACEMT ANTE CAROTID | Medium Descr | TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE | Long Descr | Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 |
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. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 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 | CG | Policy criteria applied | GC | This service has been performed in part by a resident under the direction of a teaching physician | GX | Notice of liability issued, voluntary under payer policy | LT | Left side (used to identify procedures performed on the left side of the body) | 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) | 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 | Added | Added |
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