Lower Extremity Endovascular Revascularization

CPT codes 37220-37235 are reported for interventions of the lower extremities for treatment of occlusive disease and include angioplasty, atherectomy and stent placements. There are three vascular territories for coding purposes in the lower extremities. They are the iliac territory, the femoral/popliteal territory and the tibial/peroneal territory. There is a hierarchy that must be followed when reporting these interventions which is a stent with atherectomy supersedes atherectomy, which supersedes stent, which supersedes angioplasty when performed in the same vessel territory.


Some coding tips to remember:

Only one intervention can be reported for the femoral/popliteal territory, which includes the common femoral, profunda, superficial femoral and popliteal arteries. Because only one intervention can be reported it would be appropriate to combine all interventions performed in this territory for the same leg together, and report the most complex intervention only.  Some examples are:

  • Atherectomy and angioplasty were performed on the right superficial femoral artery and a stent was placed in the right common femoral artery. Since only one intervention can be reported for this territory it would be appropriate to combine the interventions together and report the more complex code of 37227 which captures the stent and atherectomy in the femoral/popliteal territory.
  • Atherectomy was performed on the left superficial femoral artery and a stent was placed in the left popliteal artery. Code one instance of 37227 which captures the stent and atherectomy performed within the unilateral femoral/popliteal territory.

Bridging lesions are coded as a single vessel intervention even when the lesion extends across two separate vascular territories. The current recommendation is to report the intervention to the most distal territory intervened upon.  For example:

  • A stent was placed in a lesion that extended from the distal right external iliac artery into the right common femoral artery. Report only one intervention and use the most distal vascular territory treated, CPT code 37226 for the femoral/popliteal artery stent placement.
  • An angioplasty was performed on a bridging lesion involving the left below-knee popliteal artery that extended down into the left tibioperoneal trunk artery. Report only the most distal vessel intervention which is the tibioperoneal trunk angioplasty, CPT code 37228.

The tibial/peroneal territory includes only three vessels that are considered separate for reporting purposes. These three vessels are the anterior tibial, posterior tibial and peroneal artery.  The tibioperoneal trunk is considered part of any distal intervention in the posterior tibial or peroneal artery.  It is not considered a part of the anterior tibial artery and if separate and distinct lesions are treated in the anterior tibial artery and tibioperoneal trunk two interventions are reported.  Some examples of tibial/peroneal territory interventions are:

  • Atherectomy was performed in the distal left anterior tibial artery and a stent was placed in the left tibioperoneal trunk for a 90% stenosis. Report the more complex intervention, based on the hierarchy for these codes, in the anterior tibial artery as the initial service with CPT code 37229 and the stent placement in the tibioperoneal trunk as a separate intervention using add on CPT code 37234.
  • Atherectomies were performed on separate and distinct lesions in the left tibioperoneal trunk, anterior tibial and posterior tibial arteries. Report only two interventions for this scenario since the tibioperoneal trunk intervention is included in the posterior tibial intervention.  The correct CPT codes would be one instance of CPT code 37229 and one instance of add on CPT code 37233 for the additional atherectomy in the tibial/peroneal territory.

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The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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