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The procedure described by CPT® Code 37235 involves the revascularization of an additional ipsilateral (same side) occluded or stenosed tibial or peroneal artery. This is achieved through endovascular techniques, which can be performed either openly or percutaneously. The process includes the use of angioplasty, atherectomy, and the placement of transluminal stents. Angioplasty is a method where a catheter with a balloon tip is advanced to the site of the blockage, and the balloon is inflated to compress plaque against the arterial wall, potentially requiring multiple inflations to achieve optimal results. Alternatively, atherectomy may be utilized, which involves a specialized catheter that shaves plaque from the artery using a cutting piston. This plaque is then collected within the device for removal after the procedure. Following these interventions, a completion angiography is performed to confirm the patency of the artery, and if necessary, a stent is deployed to maintain the artery's openness. This code is specifically used for each additional vessel treated in this manner, and it is important to note that it is billed separately in addition to the primary procedure code.
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The procedure is indicated for patients presenting with occluded or stenosed tibial or peroneal arteries, particularly when there is a need for revascularization to restore blood flow. This may be due to conditions such as peripheral artery disease (PAD), which can lead to ischemia and other complications if not addressed. The procedure is performed when there is a clinical necessity to treat additional vessels on the same side that have not responded to conservative management or when symptoms persist despite other interventions.
The procedure begins with the physician accessing the vascular system, typically through the femoral artery, to reach the tibial or peroneal arteries. Once access is obtained, a guidewire is introduced, and a catheter with a balloon tip is advanced over the guidewire to the site of the occluded artery. The balloon is then inflated, which compresses the plaque against the arterial wall, potentially requiring multiple inflations to achieve the desired luminal diameter. If necessary, an atherectomy may be performed, where a specialized catheter with a cutting piston is used to shave plaque from the arterial wall. This plaque is collected within the device for removal upon completion of the procedure. After the atherectomy, the angioplasty device is exchanged for a guidewire, and an angiography catheter is advanced over the guidewire. The guidewire is then withdrawn, and contrast material is injected to perform a completion angiography, ensuring that the artery is patent. If the angiography indicates that a stent is required to maintain the artery's patency, a stent delivery catheter is advanced to the lesion site, where the stent is carefully positioned and deployed. Following stent placement, the stent delivery catheter is removed, and a balloon catheter may be advanced and inflated to ensure the stent is properly seated.
Post-procedure care involves monitoring the patient for any complications such as bleeding, hematoma formation, or signs of re-occlusion. Patients may be advised to rest and avoid strenuous activities for a specified period. Follow-up appointments are typically scheduled to assess the success of the procedure and the patency of the treated arteries through physical examination and possibly additional imaging studies. Patients may also receive instructions regarding medication management, including antiplatelet therapy to prevent thrombus formation at the stent site.
| Short Descr | TIB/PER REVASC STNT & ATHER | Medium Descr | REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL | Long Descr | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 2 | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 37231 | MPFS Status: Active Code APC J1 ASC J8 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed | 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) |
| 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. | 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.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | 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 | 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. |
| 2011-01-01 | Added | Added |
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