From the Experts: Vascular Surgery Coding Guidelines 2021

The Society for Vascular Surgery states that vascular surgery encompasses the diagnosis and comprehensive treatment of disorders of the arterial, venous, and lymphatic systems. However, it excludes intracranial and coronary arteries. An arterial surgery procedure is an operation that includes the aorta, arteries, and veins in the neck, abdomen, pelvis, legs, and arms, except for those in the heart and brain. As a result, diplomates in vascular surgery must have considerable experience treating patients with all types of vascular disease. It should include diagnosis, treatment, and endovascular and reconstructive vascular procedures.  

To report transcatheter peripheral vascular interventions in the lower extremities with an occlusive disease, use the following vascular surgery coding. The bundled codes have three parts: iliac, femoral/popliteal, and tibial/peroneal. 

Traversing the lesion, radiological supervision, accessing the vessel, and interpretation related to the intervention performed. Furthermore, the closure of the arteriotomy by pressure, embolic protection (if or not necessary), application of an arterial closure device or standard closure of the puncture by suture, and imaging to record completion of the intervention(s) performed are included. The arrangement of these codes is in a progressive hierarchy. It means that more intensive services are inclusive of the lesser services.

Iliac Vascular Territory

The iliac territory consists of three vessels: the internal iliac, the external iliac, and the common iliac.

37220 — Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty

37221 — Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed

+37222 — Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)

+37223 — Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)

Code source: American Medical Association. CPT 2021 Professional Edition

To report for initial iliac artery treatment in each leg, you should utilize primary codes. If more than one vessel in the iliac territory undergoes treatment within the territory, additional codes are reported. It is not appropriate to report an add-on code if there are distinct lesions within the same vessel.

Femoral/Popliteal Vascular Territory

Femoral/popliteal territory is in one extremity. Its treatment belongs to one vessel. If multiple lesions are treated, report only one code for the most intensive procedure.

37224 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty

37225 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel when performed

37226 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel when performed

37227 — Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel when performed.

Code source: American Medical Association. CPT 2021 Professional Edition

Tibial/Peroneal Territory 

The tibial/peroneal territory consists of three vessels: the anterior tibial, posterior tibial, and peroneal arteries.

37228 — Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty

37229 — Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel when performed

37230 — Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel when performed 

37231 — 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

+37232 — 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 — 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 — 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

+37235 — 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)

Code source: American Medical Association. CPT 2021 Professional Edition

To report for initial iliac artery treatment in each leg, you should utilize primary codes. If more than one vessel in the tibial/peroneal territory undergoes treatment within the territory, additional codes are reported. It is not appropriate to report an add-on code if there are distinct lesions within the same vessel.

The common tibioperoneal trunk is part of the tibial/peroneal territory. Its treatment is not in a separate vessel.

Additional Updates for Vascular Surgery Coding Guidelines

Memorizing a lot of codes, let alone this vascular surgery coding is too challenging. That’s why we have compiled this list for guiding vascular surgeons. 

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