How To Use CPT Code 37221

CPT 37221 refers to the revascularization of the iliac artery through endovascular, open, or percutaneous approaches with transluminal stent placement. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 37221.

1. What is CPT 37221?

CPT 37221 is a medical procedure code used to describe the revascularization of a narrowed or blocked unilateral iliac artery through endovascular, open, or percutaneous approaches. This procedure involves the placement of a transluminal stent to restore blood flow in the affected artery. It is used when the provider performs this procedure on an initial vessel and includes angioplasty within the same vessel when performed.

2. 37221 CPT code description

The official description of CPT code 37221 is: “Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed.”

3. Procedure

  1. The patient is appropriately prepped and anesthetized.
  2. The provider makes a small incision or inserts a needle through the skin to puncture the occluded artery.
  3. A guidewire is introduced through the opening, followed by a catheter.
  4. Arteriography is used as imaging guidance to advance the stent-delivering catheter to the site of occlusion.
  5. The stent is placed at the site of occlusion and expanded against the wall of the lumen to increase the diameter of the vessel.
  6. Angiography is used to confirm the stent’s position.
  7. The catheter is withdrawn, and the incision or puncture site is sutured.
  8. The patient’s vital signs and stability are monitored.

4. Qualifying circumstances

Patients eligible to receive CPT 37221 services are those with a narrowed or blocked unilateral iliac artery that requires revascularization. This procedure is indicated when conservative treatments, such as medications and lifestyle changes, have not been effective in improving blood flow and relieving symptoms. Patients with significant stenosis, occlusion, or aneurysm in the iliac artery may also be candidates for this procedure.

5. When to use CPT code 37221

It is appropriate to bill CPT code 37221 when the provider performs revascularization of the iliac artery through endovascular, open, or percutaneous approaches with transluminal stent placement on an initial vessel. This code should be used when angioplasty is performed within the same vessel during the procedure.

6. Documentation requirements

To support a claim for CPT 37221, the following information should be documented:

  • Patient’s medical history and physical examination findings
  • Indications for the procedure, such as symptoms and severity of the iliac artery stenosis or occlusion
  • Details of the procedure, including the approach used, stent placement, and angioplasty (if performed)
  • Imaging studies, such as arteriography, used during the procedure
  • Post-procedure monitoring and patient’s response to the treatment
  • Any complications or adverse events encountered during the procedure

7. Billing guidelines

When billing for CPT 37221, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT 37221 include:

  • Use +37222 when the provider restores the blood supply in each additional stenosed ipsilateral unilateral iliac artery through endovascular, open, or percutaneous approaches with transluminal angioplasty.
  • Use +37223 when the provider restores the blood supply in each additional stenosed unilateral initial iliac artery through endovascular, open, or percutaneous approaches with transluminal stent placement. Angioplasty within the same vessel may also be performed during this procedure.
  • Use 37220 when the provider restores the blood supply in the stenosed unilateral initial iliac artery through an endovascular, open, or percutaneous approach with transluminal angioplasty.
  • Use 37220 and 37221 in conjunction with 34701-34711, 34718, 34845, 34846, 34847, and 34848 only when 37220 or 37221 is performed outside the treatment zone of the endograft.

8. Historical information

CPT 37221 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Similar codes to CPT 37221

Five similar codes to CPT 37221 and how they differentiate from CPT 37221 are:

  1. CPT 37220: Involves revascularization of the iliac artery with transluminal angioplasty, without stent placement.
  2. +37222: Used for each additional stenosed ipsilateral unilateral iliac artery with transluminal angioplasty, not stent placement.
  3. +37223: Used for each additional stenosed unilateral initial iliac artery with transluminal stent placement, including angioplasty within the same vessel when performed.
  4. CPT 34701-34711: These codes describe endovascular repair of the iliac artery using an endograft.
  5. CPT 34718: This code describes endovascular repair of the iliac artery using an iliac branch endoprosthesis.

10. Examples

Here are 10 detailed examples of CPT code 37221 procedures:

  1. A patient with severe unilateral iliac artery stenosis undergoes endovascular revascularization with stent placement and angioplasty within the same vessel.
  2. A patient with a unilateral iliac artery occlusion undergoes percutaneous revascularization with stent placement.
  3. An individual with a narrowed iliac artery due to atherosclerosis undergoes open revascularization with stent placement and angioplasty within the same vessel.
  4. A patient with a unilateral iliac artery aneurysm undergoes endovascular revascularization with stent placement to prevent rupture.
  5. A patient with peripheral artery disease and significant unilateral iliac artery stenosis undergoes endovascular revascularization with stent placement to improve blood flow.
  6. An individual with a history of failed conservative treatments for iliac artery stenosis undergoes percutaneous revascularization with stent placement.
  7. A patient with a unilateral iliac artery occlusion due to a blood clot undergoes open revascularization with stent placement to restore blood flow.
  8. An individual with a narrowed iliac artery due to plaque buildup undergoes endovascular revascularization with stent placement and angioplasty within the same vessel to improve blood flow.
  9. A patient with a history of smoking and diabetes undergoes percutaneous revascularization with stent placement for a unilateral iliac artery stenosis.
  10. An individual with a unilateral iliac artery aneurysm at risk of rupture undergoes open revascularization with stent placement to prevent complications.

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