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Official Description

Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 37229 involves the revascularization of a tibial or peroneal artery that has become occluded or narrowed due to conditions such as atherosclerosis. This revascularization can be performed through either an open surgical approach or a percutaneous (minimally invasive) technique. The primary goal of this procedure is to restore blood flow to the affected artery, which is crucial for maintaining proper circulation in the lower extremities. The physician utilizes a combination of techniques, including angioplasty and atherectomy, to achieve this goal. Angioplasty involves the use of a balloon catheter to dilate the narrowed artery, while atherectomy employs a specialized device to remove plaque buildup from the arterial wall. The procedure may also include the placement of a stent to keep the artery open after treatment. The choice between open and percutaneous approaches depends on various factors, including the patient's condition and the specific anatomy of the artery being treated. Overall, this procedure is essential for patients experiencing symptoms related to peripheral artery disease, as it can significantly improve blood flow and alleviate symptoms such as pain and cramping in the legs.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 37229 is indicated for patients who present with occlusion or stenosis of the tibial or peroneal arteries. The following conditions may warrant this procedure:

  • Peripheral Artery Disease (PAD) Patients suffering from PAD may experience reduced blood flow to the limbs, leading to symptoms such as claudication, pain, or cramping in the legs during physical activity.
  • Critical Limb Ischemia This severe form of PAD can result in rest pain, non-healing wounds, or ulcers, necessitating revascularization to prevent limb loss.
  • Acute Limb Ischemia Sudden loss of blood flow to the limb due to embolism or thrombosis may require urgent intervention to restore circulation.

2. Procedure

The procedure for CPT® Code 37229 involves several critical steps to ensure successful revascularization of the tibial or peroneal artery:

  • Step 1: Access Site Preparation The physician begins by preparing the skin over the access artery, which is typically one of the femoral arteries, for a percutaneous approach. If an open approach is chosen, the skin over the access artery is prepped and incised to expose the artery.
  • Step 2: Artery Access For a percutaneous approach, a needle is used to puncture the artery, and a sheath is placed to facilitate the introduction of other devices. In an open approach, the artery is exposed and nicked to allow for sheath placement.
  • Step 3: Guidewire Insertion Under radiological supervision, a guidewire is inserted through the sheath and advanced into the occluded tibial or peroneal artery. Roadmapping angiograms are obtained to visualize the artery and the extent of the occlusion.
  • Step 4: Angioplasty A catheter with a balloon tip is advanced over the guidewire to the site of the occlusion. The balloon is inflated to compress the plaque against the arterial wall, and this may be repeated several times to achieve optimal results.
  • Step 5: Atherectomy (if performed) Alternatively, atherectomy may be performed using a specialized balloon catheter that has a cutting piston. This device shaves plaque from the arterial wall, which is then collected in the device for removal upon completion of the procedure.
  • Step 6: Completion Angiography After the angioplasty or atherectomy, the angioplasty device is exchanged for a guidewire, and an angiography catheter is advanced. Contrast is injected, and completion angiography is performed to confirm that the artery is patent.
  • Step 7: Stent Placement (if necessary) If an intravascular stent is required to maintain patency, the stent delivery catheter is advanced to the lesion site, positioned, and deployed. A balloon catheter may be used again to ensure the stent is properly seated.
  • Step 8: Closure After all catheters are removed, if an open approach was used, the access artery is repaired, and the skin incision is closed. For a percutaneous approach, pressure is applied to the vascular access site, and a pressure dressing is applied to prevent bleeding.

3. Post-Procedure

Post-procedure care for patients undergoing the revascularization procedure includes monitoring for complications such as bleeding or hematoma at the access site. Patients may be advised to rest and limit physical activity for a specified period to promote healing. Follow-up appointments are typically scheduled to assess the success of the procedure and to monitor for any recurrence of symptoms. Additionally, patients may be prescribed medications to manage risk factors associated with peripheral artery disease, such as antiplatelet agents or statins, to improve long-term outcomes.

Short Descr TIB/PER REVASC W/ATHER
Medium Descr REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
Long Descr Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
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 Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P2F - Major procedure, cardiovascular-Other
MUE 1
CCS Clinical Classification 61 - Other OR procedures on vessels other than head and neck

This is a primary code that can be used with these additional add-on codes.

37232 Addon Code MPFS Status: Active Code APC N ASC N1 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
37233 Addon Code MPFS Status: Active Code APC N ASC N1 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
37234 Addon Code MPFS Status: Active Code APC N ASC N1 Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
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)
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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).
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.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
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
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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.
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
AG Primary physician
GW Service not related to the hospice patient's terminal condition
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
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.)
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.
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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).
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).
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
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.)
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)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
PT Colorectal cancer screening test; converted to diagnostic test or other procedure
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
Q5 Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SG Ambulatory surgical center (asc) facility service
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
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
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2017-01-01 Changed Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category.
2011-01-01 Added Added
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