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The procedure described by CPT® Code 37606 involves the ligation of the internal or common carotid artery using a method known as gradual occlusion, which is facilitated by specialized clamps such as the Selverstone or Crutchfield clamp. This surgical intervention is performed to manage conditions affecting cerebral blood flow, particularly when there is a need to evaluate and control blood supply to the brain. The process begins with an incision over the carotid artery bifurcation, allowing the surgeon to dissect through the soft tissues to access both the common and internal carotid arteries. A critical step in this procedure is the puncturing of the internal carotid artery to insert a pressure recording device, which is advanced toward the base of the skull. This device is essential for monitoring internal carotid pressures throughout the procedure, ensuring that cerebral perfusion is adequately assessed. The common carotid artery is typically the preferred site for ligation; however, if cerebral blood flow is found to be inadequate, the internal carotid artery may be targeted instead. The gradual occlusion technique involves the careful application of the clamp to reduce blood flow incrementally, allowing for close monitoring of the patient's neurovascular status. This method is particularly beneficial as it provides a controlled approach to occlusion, which can be adjusted over several days, ensuring that the patient can tolerate the changes in blood flow before finalizing the ligation.
© Copyright 2025 Coding Ahead. All rights reserved.
The ligation of the internal or common carotid artery using gradual occlusion is indicated for specific conditions that necessitate careful management of cerebral blood flow. The following are the primary indications for this procedure:
The procedure for ligation of the internal or common carotid artery with gradual occlusion involves several critical steps, each designed to ensure safety and effectiveness:
After the ligation procedure, patients are typically monitored for any changes in neurovascular status and overall recovery. It is essential to observe for signs of cerebral ischemia or other complications that may arise from the occlusion. The clamp remains in place for a specified duration, during which the patient's response to the gradual occlusion is assessed. Follow-up evaluations are necessary to ensure that cerebral blood flow remains adequate and to determine if further intervention is required. Post-procedure care may include imaging studies to monitor the status of the carotid arteries and adjustments to the occlusion as needed based on the patient's condition.
| Short Descr | LIG INT/COM CAROTID ART OCCL | Medium Descr | LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION | Long Descr | Ligation; internal or common carotid artery, with gradual occlusion, as with Selverstone or Crutchfield clamp | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply 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 | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 59 - Other OR procedures on vessels of head and neck |
| 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). | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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