How To Use CPT Code 37229

CPT 37229 describes the revascularization procedure for the tibial or peroneal artery using an endovascular, open, or percutaneous 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 37229?

CPT 37229 is used to describe the revascularization procedure for the tibial or peroneal artery. This procedure involves restoring the blood supply in the affected artery using an endovascular, open, or percutaneous approach. The provider may also perform an atherectomy, which is the removal of plaque from the blood vessel. Additionally, this code includes an angioplasty procedure if it is performed within the same vessel.

2. Official Description

The official description of CPT code 37229 is: ‘Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed.’

3. Procedure

1. The provider begins by assessing the area of arterial occlusion in the tibial or peroneal artery.
2. Depending on the approach chosen, the provider either makes an incision over the leg to access the artery (open approach) or punctures the artery through the skin (percutaneous approach).
3. The provider then irrigates the occluded artery with a heparin saline solution to improve blood flow.
4. A balloon catheter is inserted into the artery and inflated to dilate the narrowed section of the vessel (angioplasty).
5. After angioplasty, the provider removes the balloon catheter and inserts a rotational atherectomy device, also known as a burr catheter, to remove plaque from the inner wall of the artery.
6. The provider uses an angioscope to check the patency of the vessel and the extent of revascularization.
7. Finally, the provider either applies a compression bandage over the puncture site (percutaneous approach) or sutures the soft tissue layers (open approach) to complete the procedure.

4. Qualifying circumstances

CPT 37229 is used for patients who require revascularization of the tibial or peroneal artery due to arterial occlusion. The procedure is performed unilaterally, meaning it is done on one side of the body. The patient must have an initial vessel that requires revascularization, and the provider may also perform an atherectomy and angioplasty within the same vessel if necessary.

5. When to use CPT code 37229

CPT code 37229 should be used when the provider performs the initial revascularization procedure on the tibial or peroneal artery using an endovascular, open, or percutaneous approach. This code includes the atherectomy procedure and angioplasty within the same vessel if performed. It is important to note that this code should not be reported if the provider is performing additional revascularization procedures on the same or different vessels.

6. Documentation requirements

To support a claim for CPT 37229, the provider must document the following information:

• Patient’s diagnosis and the need for revascularization
• Specific approach used (endovascular, open, or percutaneous)
• Date of the procedure
• Details of the procedure, including atherectomy and angioplasty if performed
• Extent of revascularization and patency of the vessel
• Method of closure (compression bandage or sutures)
• Signature of the provider

7. Billing guidelines

When billing for CPT 37229, ensure that the procedure meets the criteria for revascularization of the tibial or peroneal artery using the specified approach. It is important to note that this code should not be reported with other codes for additional revascularization procedures on the same or different vessels. Additional tips for reporting CPT 37229 may include using specific modifiers or additional codes for transluminal angioplasty or stent placement, depending on the specific circumstances of the procedure.

8. Historical information

CPT 37229 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Examples

1. A patient with arterial occlusion in the tibial artery undergoes an endovascular revascularization procedure with atherectomy and angioplasty.
2. A provider performs an open revascularization procedure on the peroneal artery for a patient with arterial occlusion, including atherectomy and angioplasty.
3. Using a percutaneous approach, a provider performs a revascularization procedure on the tibial artery with atherectomy and angioplasty for a patient with arterial occlusion.
4. A patient with arterial occlusion in the peroneal artery undergoes an endovascular revascularization procedure with atherectomy and angioplasty.
5. A provider performs an open revascularization procedure on the tibial artery for a patient with arterial occlusion, including atherectomy and angioplasty.