How To Use CPT Code 37225

CPT 37225 refers to a revascularization procedure performed on the femoral or popliteal artery, involving atherectomy and possibly angioplasty. This article will cover the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 37225.

1. What is CPT 37225?

CPT 37225 is a medical code used to describe a specific type of revascularization procedure performed on the femoral or popliteal artery. This procedure involves atherectomy, which is the removal of plaque from the blood vessel, and may also include angioplasty within the same vessel when performed. The purpose of this procedure is to restore blood flow in a narrowed or blocked artery.

2. 37225 CPT code description

The official description of CPT code 37225 is: “Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed.”

3. Procedure

The 37225 procedure involves the following steps:

1. The provider accesses the lumen of the diseased vessel through an open or percutaneous approach to treat an area of arterial occlusion.
2. In an open approach, the provider performs a vertical incision over the femoral triangle to access the femoral artery. In the case of a popliteal artery occlusion, the provider extends the incision through the femoral triangle and down to reach the back of the knee to expose the stenosed popliteal artery. In a percutaneous approach, the provider punctures the artery through the skin to reach the occlusion.
3. The provider grasps the obstructed artery using a vascular clamp and performs an arterial irrigation by infusing a heparin saline into the occluded artery.
4. Next, the provider passes a balloon catheter through a guidewire into the artery to reach the area of vessel obstruction. The balloon is inflated to dilate the stenosed artery, and then removed through the site of access.
5. The provider inserts a rotational atherectomy device, or burr catheter, under radiological guidance to the site of treatment with the assistance of the guidewire. The atherosclerotic plaque is dislodged from the inner wall of the diseased artery using the burr catheter.
6. The provider checks the patency of the occluded vessel and extent of revascularization through an angioscope at the end of the treatment session.
7. Finally, the provider withdraws the atherectomy catheter system through the site of access and stops bleeding by applying a compression bandage over the puncture location (in a percutaneous approach) or repairs the vertical incision by suturing the soft tissue in layers (in an open procedure).

4. Qualifying circumstances

Patients eligible to receive CPT code 37225 services are those with a narrowed or blocked unilateral femoral or popliteal artery due to atherosclerosis or other causes. The provider must determine that the patient requires revascularization to restore blood flow and that atherectomy, with or without angioplasty, is the most appropriate treatment option.

5. When to use CPT code 37225

It is appropriate to bill the 37225 CPT code when the provider performs a revascularization procedure on the femoral or popliteal artery involving atherectomy, and possibly angioplasty within the same vessel when performed. The procedure can be performed using an endovascular, open, or percutaneous approach.

6. Documentation requirements

To support a claim for CPT 37225, the following information should be documented:

• Patient’s medical history and physical examination findings, including symptoms and risk factors for arterial occlusion.
• Diagnostic tests and imaging studies confirming the presence of a narrowed or blocked femoral or popliteal artery.
• Provider’s assessment and plan, including the rationale for selecting atherectomy and the chosen approach (endovascular, open, or percutaneous).
• Detailed description of the procedure, including all steps performed and any complications encountered.
• Post-procedure assessment, including the success of the revascularization and any follow-up care or additional interventions required.

7. Billing guidelines

When billing for CPT code 37225, it is essential to follow the specific guidelines and rules set forth by the payer. Some tips for billing this code include:

• Ensure that all required documentation is complete and accurate, as outlined in the documentation requirements section.
• Verify that the patient meets the qualifying circumstances for the procedure, as described earlier in this article.
• Be aware of any payer-specific rules or requirements related to billing for CPT 37225, such as prior authorization or additional documentation requests.

8. Historical information

CPT 37225 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 37225

Five similar codes to CPT 37225 and how they differ are:

1. CPT 37224: Involves revascularization with transluminal angioplasty, without atherectomy.
2. CPT 37226: Involves revascularization with transluminal stent placements, and may include angioplasty within the same vessel, without atherectomy.
3. CPT 37227: Involves revascularization with transluminal stent placements and atherectomy, and may include angioplasty within the same vessel.
4. CPT 37228: Involves revascularization of the tibial, peroneal artery, or both, with atherectomy, and may include angioplasty within the same vessel.
5. CPT 37229: Involves revascularization of the tibial, peroneal artery, or both, with transluminal stent placements and atherectomy, and may include angioplasty within the same vessel.

10. Examples

Here are 10 detailed examples of CPT code 37225 procedures:

1. A 65-year-old patient with peripheral artery disease undergoes atherectomy and angioplasty of the left femoral artery using a percutaneous approach.
2. A 72-year-old patient with a history of smoking and diabetes undergoes an open atherectomy of the right popliteal artery to treat severe claudication.
3. A 58-year-old patient with atherosclerosis undergoes endovascular atherectomy and angioplasty of the left femoral artery to restore blood flow.
4. A 69-year-old patient with a history of hypertension undergoes a percutaneous atherectomy of the right popliteal artery to treat critical limb ischemia.
5. A 63-year-old patient with a history of hyperlipidemia undergoes an open atherectomy and angioplasty of the left femoral artery to treat intermittent claudication.
6. A 71-year-old patient with a history of coronary artery disease undergoes endovascular atherectomy of the right femoral artery to treat severe stenosis.
7. A 67-year-old patient with a history of stroke undergoes a percutaneous atherectomy and angioplasty of the left popliteal artery to restore blood flow.
8. A 74-year-old patient with a history of peripheral artery disease undergoes an open atherectomy of the right femoral artery to treat critical limb ischemia.
9. A 62-year-old patient with a history of smoking undergoes endovascular atherectomy of the left popliteal artery to treat severe claudication.
10. A 70-year-old patient with a history of diabetes undergoes a percutaneous atherectomy and angioplasty of the right femoral artery to treat intermittent claudication.