How To Use CPT Code 37218

CPT 37218 describes the transcatheter placement of intravascular stent(s) in the intrathoracic common carotid artery or innominate artery using an open or percutaneous antegrade approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 37218?

CPT 37218 is used to describe the placement of one or more stents in the intrathoracic common carotid artery or innominate artery using a catheter. The procedure can be performed through an open or percutaneous antegrade approach, which means in the normal direction of flow. The service may also include angioplasty, a procedure to widen the artery. The provider also performs radiologic supervision and interpretation for the procedure.

2. Official Description

The official description of CPT code 37218 is: ‘Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation.’

3. Procedure

1. The provider begins the procedure by accessing the intrathoracic common carotid artery or innominate artery using either an open or percutaneous antegrade approach.
2. Using fluoroscopic guidance, the provider moves a catheter through the vessels, administering contrast material as needed to help with guidance and analysis of the vascular abnormality.
3. The provider may perform angioplasty to prepare the site, typically by inflating a balloon on the catheter to push the plaque against the artery wall.
4. The provider then advances a catheter stent system into the vessel under fluoroscopic guidance and deploys the stent to increase the diameter of the vessel and relieve blockage.
5. After withdrawing the catheter, the provider ensures hemostasis and closes the incision with sutures.

4. Qualifying circumstances

CPT 37218 is performed on patients with a confirmed need for stenting in the intrathoracic common carotid artery or innominate artery. The procedure is indicated when the ipsilateral extracranial intrathoracic carotid arteriogram confirms the need for stenting. It is important to note that CPT 37218 should not be reported if the treated carotid artery has already been reported with CPT codes 36222, 36223, or 36224. The procedure is typically performed by a provider with expertise in interventional radiology or vascular surgery.

5. When to use CPT code 37218

CPT code 37218 should be used when the provider performs the transcatheter placement of intravascular stent(s) in the intrathoracic common carotid artery or innominate artery using an open or percutaneous antegrade approach. It is important to ensure that the procedure is medically necessary and supported by the documentation.

6. Documentation requirements

To support a claim for CPT 37218, the provider must document the following information:

• Confirmation of the need for stenting based on the ipsilateral extracranial intrathoracic carotid arteriogram
• Details of the approach used (open or percutaneous antegrade)
• Date and duration of the procedure
• Specific stent(s) used
• Angioplasty, if performed
• Radiological supervision and interpretation

7. Billing guidelines

When billing for CPT 37218, ensure that the procedure meets the criteria for the code and is supported by the documentation. It is important to note that CPT 37218 should not be reported if the treated carotid artery has already been reported with CPT codes 36222, 36223, or 36224. Additionally, consider the location of the testing and the need for radiological supervision and interpretation. It is recommended to review the specific billing guidelines and requirements of the payer to ensure accurate reporting.

8. Historical information

CPT 37218 was added to the Current Procedural Terminology system on January 1, 2015. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A vascular surgeon performing a transcatheter placement of intravascular stent(s) in the intrathoracic common carotid artery using an open antegrade approach, including angioplasty, for a patient with severe stenosis.
2. An interventional radiologist performing a percutaneous antegrade transcatheter placement of intravascular stent(s) in the innominate artery, including angioplasty, for a patient with occlusion.
3. A cardiovascular surgeon performing a transcatheter placement of intravascular stent(s) in the intrathoracic common carotid artery using an open antegrade approach, including angioplasty, for a patient with atherosclerosis.
4. An interventional radiologist performing a percutaneous antegrade transcatheter placement of intravascular stent(s) in the innominate artery, including angioplasty, for a patient with a vascular abnormality.