cpt 37227, cpt code 37227, 37227 cpt code

CPT Code 37227 | Description, Guidelines, Reimbursement, Modifiers & Example

CPT code 37227 can be used for Endovascular Revascularization. A stenosed or narrowed femoral or popliteal artery can open, repair percutaneously, or reopen endovascularly. The 37227 CPT code procedure is transluminal, which entails inserting a stent at the site of a blood vessel obstruction and expanding it against the narrow part of the vessel. 

Physicians can use atherectomy, a surgical procedure that removes plaque from a blood vessel. An angioplasty performs in the same boat as the system included in this code. CPT 37220 – CPT 37235 can be reported to document lower extremity interventions for the treatment of occlusive disease. 

The body parts are classified using tropospheric zones of the lower extremities. The three major regions are the tibial/peroneal territory, the iliac territory, and the femoral/popliteal territory. The femoral/popliteal region includes the profound, shared, superficial, and popliteal arteries. 

Remember that only one intervention can be recorded for this territory; grouping all interventions performed for the same leg would be acceptable.

Some examples of this are as follows:

An atherectomy and angioplasty on the right superficial and common femoral arteries perform as part of a procedure. Report CPT code 37227 in this case because only one system can be documented here. This is preferable to submitting separate codes for the femoral/popliteal stent and atherectomy (which combines all these procedures).

A left superficial femoral artery atherectomy can perform on the left leg, and the left popliteal artery was stent-placed. The unilateral femoral/popliteal area should treat with a stent and atherectomy, which can be reported as CTP 37227.

Even if a bridging lesion crosses two vascular regions, it is considered a single-vessel intervention. The current recommendation is that the intervention report to the territory that was farthest away from it. 

A lesion that extended from the distal end of the right external iliac artery to the suitable standard femoral artery stent.

CPT code 37226 represents only one intervention, and the most remote vascular location will treat by inserting an arterial stent in the popliteal artery. Because it is the most proximal vessel intervention, only the tibioperoneal trunk angioplasty, CPT code 37228, should be reported.

Any distal procedure on the posterior tibial or peroneal artery includes the tibioperoneal trunk. Only three veins in the tibial/peroneal region are considered independent for reporting purposes.

37227 CPT Code Description

CPT code 37227 can be used for heart or circulatory systems procedures. Endovascular, skin-accessed, open courses such as plaque removal and stent insertion can be billed with the 37227 CPT code.

The official description of CPT 37227, as described in CPT’s manual, is: “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”

A publicly accessible database lists all providers who have submitted Medicare claims with this code. The costs associated with this procedure are listed below.

Because the femoral-popliteal distribution contains all vascular segments in a unilateral form, only primary codes should provide. However, a single code can use to represent all of the work done in this area.

PTA can use in addition to any of these procedures; each leg has only one femoral-popliteal “vessel,” and only one primary femoral-popliteal code can report.

Therefore, instead of two separate stenting procedures, a single treatment for a single lesion that crosses a vascular bifurcation should classify as single-vessel therapy. 

Because both stenting and atherectomy can be used to open the “vessel,” which includes the entire SFA and popliteal sections for coding purposes, CPT code 37227 can be reported. The procedures can classify by vessel rather than the lesion. 

During an angioplasty, a catheter with a balloon attached can insert into the artery. When the balloon is inflated and pushed outside the occlusion, it widens the opening and increases blood flow.

The balloon is then inflated and released into the sky. All types of balloon angioplasty, including low-profile, cutting balloons, and cranioplasty, are treated equally for coding purposes.

All atherectomy cutting methods (directed, rotational, and laser) are treated the same in terms of coding. For example, a mesh tube called a stent keeps an artery open. It is placed and “opened” at the site of an obstruction to restore blood flow, much like a balloon.

However, unlike a balloon, a stent is left in place after the procedure is complete. Regarding coding, balloon-expandable, self-expanding, bare metal, coated, and drug-eluting stents will treat the same way.

Billing Guidelines

Medicare does not cover preventive stenting if the patient does not have an objectively related symptom or functional impairment. However, Medicare may cover stents for non-coronary intravascular arteries covered by an IDE (Investigational Device Exemption).

CPT 37227 can not be reported in combination with CPT 0505T within the femoral-popliteal segment.

 The FDA gives each device or stent that receives an IDE a unique identifier. The FDA’s status influences whether Medicare covers an IDE device. If a manufacturer’s IDE approval should revoke, payment will cease (or if it fails to meet relevant IDE standards, causing FDA to withdraw it).

All supporting documentation for patients’ medical records must be available to the contractor upon request.

Documents for the 37227 CPT code must be readable and contain patient identification information on each page (e.g., complete name, dates of service[s]).

Documentation for CPT code 37227 must be signed by the doctor or non-physician practitioner who is in charge of and administers the patient’s care.

The medical record allows using the chosen ICD-10-CM code (s). In addition, the CPT code 37227 specifies the service rendered.

If the CPT 37227 procedure is medically necessary, it must be made available to patients who request it, according to the doctor who performed it. 

  • A medical background that is both relevant and useful (e.g., claudication, critical limb ischemia)
  • A physical examination of the arteries (including measurement of the ankle-brachial index)
  • Invasive diagnostic testing that can perform sooner (s)
  • a detailed summary of the angiography report
  • A detailed account of the operation’s findings

How To Use Modifiers With CPT Code 37227

CPT 37227, as the primary code, assigns the first treated artery in the three designated vascular areas. Add-on codes will give additional treated vessels in the iliac and tibial-peroneal territories. Modifiers should use to indicate that bilateral interventions must carry out. 

Report modifier 59 and CPT code 37227 for procedures involving the opposite limb. Modifier LT and Modifier RT can also be used with CPT 37227 to indicate the treatment of a bilateral ailment.

Reimbursement

The insurances must follow CPT code 37227. In addition, for any specific diagnosis to be eligible for Medicare reimbursement, this policy and the general requirements for medical necessity contained in the CMS payment policy manuals, all current CMS national coverage determinations, and all Medicare payment regulations must be followed.

Example

The case below exemplifies the correct usage of CPT code 37227.

The patient sought treatment for several anatomical abnormalities, including right SFA high-grade stenosis, proximal anterior tibial artery transient blockage, and posterior tibial artery long-segment occlusion.

PTA was used to treat the anterior tibial artery successfully. After PTA therapy for the posterior tibial lesion, an atherectomy requires due to significant elastic recoil. An enormous balloon can use to treat the SFA lesion.

The patient reported worsening pain in his right foot; examination revealed a cold, mottled area with no detectable Doppler pulse; the patient can admit to the hospital.

At the end of the angiography, the lesional opening will be high across the board, with flow visible into the foot. 

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