How To Use CPT Code 37242

CPT 37242 describes the procedure of vascular embolization or occlusion on arteries, excluding cases related to hemorrhage or tumor treatment. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 37242?

CPT 37242 is used to describe a procedure that involves partially or completely blocking arterial blood flow in a specific area. This code is specifically for services unrelated to hemorrhage or tumor treatment and is appropriate for cases involving arteriovenous malformations or fistulas, aneurysms, or pseudoaneurysms.

2. Official Description

The official description of CPT code 37242 is: ‘Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms).’ It is important to note that CPT codes 37241 and 37242 should not be reported in conjunction with CPT codes 36836 and 36837. For percutaneous treatment of extremity pseudoaneurysm, CPT code 36002 should be used.

3. Procedure

1. The patient is prepped and anesthesia is administered.
2. A percutaneous approach is used to gain access to the target arterial area.
3. A guidewire is inserted to assist with the insertion of a catheter into the vessel lumen.
4. The catheter is used to deploy embolic material, such as platinum coils, detachable balloons, dehydrated ethanol, or collagen fibers, to selectively or completely block the vascular supply.
5. The catheter system is then pulled back through the access site, and hemostasis is achieved.

4. Qualifying circumstances

CPT 37242 is applicable in cases where there is a need to perform vascular embolization or occlusion on arteries, excluding those related to hemorrhage or tumor treatment. This code is used for conditions such as congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, and pseudoaneurysms.

5. When to use CPT code 37242

CPT code 37242 should be used when performing vascular embolization or occlusion on arteries, excluding cases related to hemorrhage or tumor treatment. It is important to ensure that the procedure performed aligns with the specific conditions mentioned in the official description. If the procedure involves the treatment of extremity pseudoaneurysm, CPT code 36002 should be used instead.

6. Documentation requirements

To support a claim for CPT code 37242, the following documentation is required:

• Patient’s diagnosis and indication for vascular embolization or occlusion
• Details of the procedure performed, including the specific arterial area targeted
• Documentation of radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance
• Date and duration of the procedure
• Specific embolic material used
• Any complications or adverse events encountered
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 37242, ensure that the procedure performed aligns with the official description and qualifying circumstances. It is important to note that CPT codes 37241 and 37242 should not be reported in conjunction with CPT codes 36836 and 36837. Additionally, for percutaneous treatment of extremity pseudoaneurysm, CPT code 36002 should be used. Consider the specific guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT code 37242 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A physician performs vascular embolization to occlude an arteriovenous malformation in a patient’s brain.
2. A radiologist performs vascular embolization to treat an aneurysm in a patient’s abdominal aorta.
3. An interventional cardiologist performs vascular embolization to occlude an arteriovenous fistula in a patient’s arm.
4. An interventional radiologist performs vascular embolization to treat a pseudoaneurysm in a patient’s femoral artery.
5. A vascular surgeon performs vascular embolization to occlude an acquired arterial malformation in a patient’s leg.
6. An interventional neuroradiologist performs vascular embolization to treat an arteriovenous malformation in a patient’s spinal cord.
7. An interventional radiologist performs vascular embolization to occlude an aneurysm in a patient’s splenic artery.
8. A vascular surgeon performs vascular embolization to treat a pseudoaneurysm in a patient’s renal artery.