Interventional Part

Thrombolysis and Other Infusion Therapy

7 Vascular Interventional Coding
Thrombolysis and Other Infusion Therapy

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
Infusion therapy involves placement of a catheter into a vessel (artery or vein) and infusing a
therapeutic agent (drug) into the problematic vessel. Diagnostic angiography usually precedes
this therapeutic intervention. Infusion therapy usually requires that the infusion be performed

over a prolonged period of time (not just for a bolus injection of a thrombolytic drug). This
infusion is performed to treat an abnormality of the blood vessel, not the organ or structure the
vessel supplies. For cerebral infusion therapy, codes 61650 and 61651 apply to cerebral
non-thrombolytic infusions only, while code 61645 applies to cerebral thrombolytic infusions.

CLINICAL INDICATIONS:
Vascular ischemia related to thrombosis or embolism, cerebralvasoconstriction, vasospasm
related to subarachnoid hemorrhage requiring vasodilation therapy, bleeding requiring
vasoconstriction therapy (usually GI tract), and other catheter-directed
non-chemotherapeutic infusions. These therapies may be used in all four vascular systems
and are performed to treat blood vessel abnormalities.

CODES: PROC APC TOTAL S&I
PROCEDURE DESCRIPTION CODE RVU CODE

Thrombolysis, cerebral, by intravenous infusion 37195 5694 0.00 Bundle
d

Transcatheter therapy, arterial infusion for thrombolysis 37211 5184 11.21 Bundle
other than coronary or intracranial, any method, including d
radiological supervision and interpretation, initial treatment
day

Transcatheter therapy, venous infusion for thrombolysis, any 5183 9.82 Bundle
method, including radiological supervision and 37212 d
interpretation, initial treatment day

Transcatheter therapy, arterial or venous infusion for 37213 5182 6.79 Bundle
thrombolysis other than coronary, any method, including d
radiological supervision and interpretation, continued
treatment on subsequent day during course of thrombolytic
therapy, including follow-up catheter contrast injection,
position change, or exchange, when performed;

Transcatheter therapy, arterial or venous infusion for 37214 5182 3.56 Bundle
thrombolysis other than coronary, any method, including d
radiological supervision and interpretation, continued
treatment on subsequent day during course of thrombolytic
therapy, including follow-up catheter contrast injection,
position change, or exchange, when performed; cessation of
thrombolysis including removal of catheter and vessel
closure by any method

Percutaneous arterial transluminal mechanical
thrombectomy and/or infusion for thrombolysis, intracranial,
any method, including diagnostic angiography, fluoroscopic ♦ 61645 N/A 24.04 Bundle
guidance, catheter placement, and intraprocedural d

pharmacological thrombolytic injection(s)

Endovascular intracranial prolonged administration of Bundle
pharmacologic agent(s) other than for thrombolysis, arterial, d
including catheter placement, diagnostic angiography, and ♦ 61650 N/A 15.66

imaging guidance; initial vascular territory

Endovascular intracranial prolonged administration of N/A 6.65 Bundle
pharmacologic agent(s) other than for thrombolysis, arterial, d
including catheter placement, diagnostic angiography, and 5694 3.00
imaging guidance; each additional vascular territory (List ♦ 61651 5693 5.24
separately in addition to code for primary procedure)

Chemotherapy administration, intra-arterial; push technique 96420

Chemotherapy administration, intra-arterial; infusion 96422
technique, up to 1 hour

CODING INSTRUCTIONS:
1. Consider unlisted code 37799 for non-cerebral, non-thrombolytic catheter-directed
infusion therapy (e.g., selective SMA catheter-directed infusion of vasopressin for
treatment of UGI bleed).
2. Codes 37211-37214 are used only once per surgical field treated. These codes are not
for cerebral or coronary artery infusions. The entire lower extremity is considered one
surgical field.
3. Do not use codes 37211-37214 for cerebral thrombolytic infusions. Use code 61645 for
cerebral thrombolysis (including cerebral thrombectomy if done).
4. If bilateral lower extremity arterial thrombosis is treated by two separate catheters,
code 37211 would be billed with a -50 modifier for the initial day of therapy. Code
37213-50 would be billed for each additional day of therapy, while code 37214-50
would be for the final day of therapy. However, Medicare does not recognize a -50
modifier for payment when appended to codes 37213 and 37214.
5. If bilateral deep vein thrombosis of both lower extremities is treated by two separate
catheters, code 37212 would be billed with a -50 modifier for the initial day of therapy.
Code 37213-50 would be billed for each additional day of therapy, while code 37214-50
would be for the final day of therapy. However, Medicare does not recognize a -50
modifier for payment when appended to codes 37213 and 37214.

6. There are three cerebral arterial territories for infusion therapy and/or endovascular
revascularization: the right and left cerebral hemispheres and the posterior fossa (also
known as "right brain", "left brain", and "back of brain").

7. Use code 61650 for initial cerebral arterial territory non-thrombolytic infusion therapy
(vasospasm treatment, chemotherapy infusion). Use code 61651 for each additional
cerebral territory.

8. Up to three territories can be treated at a single session. Add-on code 61651 can be
submitted up to a maximum of two times per date of service (even if more than one
session of treatment is necessary).

9. Codes 61650 and 61651 require "prolonged" drug administration of at least ten minutes.
This can be by continuous or intermittent infusion. Do not use these codes for
"injection" of drugs such as nitroglycerine or heparin. A one-time two-minute injection
of 5 mg verapamil to treat vasospasm does not qualify for code 61650 or 61651.

10. Treatment of iatrogenically induced vasospasm is not separately coded (do not use
codes 61650 and 61651).

11. Treatment of iatrogenically induced cerebral arterial embolus is separately reported
with code 61645.

12. Codes 61645, 61650, and 61651 describe arterial procedures and bundle ipsilateral
catheter placement, diagnostic imaging, guidance, and follow-up (completion) imaging.

13. Use code 61645 for catheter-directed arterial cerebral thrombolytic infusion therapy
(per territory). This includes thrombectomy and any means to revascularize an acutely
occluded intracranial artery. Code 61645 can also be submitted if only thrombectomy is
performed without thrombolytic infusion. This code is for revascularization by any
method to treat thrombus/embolus/occlusion of cerebral arteries and bundles
intracranial angioplasty (61630) and intracranial stent placement (61635). Code 61645
includes any vasospasm therapy in the same territory, so do not report code 61650 with
code 61645.

14. Use code 37212 for initial day of cerebral venous thrombolytic infusion therapy.
15. Use code 37187 for initial day of cerebral venous thrombectomy.
16. If bilateral lower extremity arterial thrombosis is treated via a single catheter positioned

in the distal abdominal aorta, only code for one thrombolysis.
17. Catheter exchange and follow-up angiography during catheter-directed thrombolytic

infusion therapy is bundled with codes 37211-37214. This applies to both arterial and
venous thrombolytic infusions.
18. Catheter placement and diagnostic angiography are coded in addition to thrombolytic
infusion therapy codes 37211-37214. Follow-up angiography is bundled with
thrombolysis. Catheter placement in the lower extremity is coded separately for
infusion therapy, as long as it is at a separate session from a lower extremity
endovascular revascularization procedure (described by codes 37220-37235). If a short
infusion is followed by stent placement at the same session, the catheter placement is

bundled in the lower extremity endovascular revascularization procedure code.
(Catheter placement is routinely bundled with angioplasty, atherectomy, and/or stent
placement in lower extremity endovascular revascularization procedures for treatment
of occlusive disease.) A catheter placement may also be reported separately in the
lower extremities when the interventions performed are thrombolysis or iliac artery
atherectomy (0238T) without procedures described by codes 37220-37235.
19. Follow-up angiography (75898) is not billed with thrombolysis codes 37211-37214 or
procedures described by codes 61645, 61650, and 61651. It is bundled.
20. Codes 37213 and 37214 may be used for arterial or venous thrombolytic infusions.
21. If thrombolysis is completed during the initial day of therapy, only submit code 37211 or
37212. Do not use code 37214 for completion.
22. If thrombolysis is concluded on the second day of therapy, only submit code 37214 for
this final day of therapy.
23. Use code 37213 for each day of therapy that is not the first or last day of therapy.
24. Any intervention done before, during,or after infusion therapy should be coded
separately (e.g., angioplasty or stent placement).
25. Percutaneous thrombectomy codes include intraprocedural thrombolysis. Do not use
codes 37211-37214 for thrombolysis used "a little" before, during, or after
thrombectomy. If prolonged catheter-directed thrombolysis by infusion technique is
performed for a substantial time before or after thrombectomy is performed, then it
may be appropriate to use code 37211 or 37212 for the initial day of infusion. These will
require a -59 modifier to differentiate this prolonged separate infusion from
intraprocedural thrombolysis, which is bundled during thrombectomy.
26. Use code 37211 for prolonged non-cerebral arterial infusion thrombolysis performed
before or after percutaneous thrombectomy. Use code 37212 for prolonged
catheter-directed venous infusion thrombolysis before or after percutaneous
thrombectomy.
27. Use arterial infusion code 37211 for pulmonary artery infusion for thrombolysis.
28. Do not use code 37211 or 37212 for intraprocedural thrombolysis utilized during
percutaneous thrombectomy. Intraprocedural infusion therapy during percutaneous
thrombectomy is bundled into the thrombectomy code.
29. Although infusion therapy codes do not have a specified time requirement for minimal
duration of infusion, some LCDs do have guidance for the time of infusion. Regardless,
never report an infusion procedure code for a transcatheter bolus or injection of a
thrombolytic or non-thrombolytic agent. An injection is not an infusion. Intracranial
arterial administrations may be continuous or intermittent, but codes 61650 and 61651
only apply when the drug administration duration is at least ten minutes.
30. Use code 36593 when short-term thrombolytic agent infusion is given to clear a central
venous catheter. (This may be a bolus injection or a short one to four hour infusion into
the catheter for catheter clearance.)

31. Do not use any code other than "J" codes for drugs (hospital only) for the bolus injection
of medications (e.g., Priscoline, nitroglycerine, heparin) via the catheter.

32. Do not use any code for injection of drugs directly into the wall of an artery (to prevent
intimal hyperplasia or recurrent stenosis) using specialized balloon technologies. This is
considered an injection and is not an infusion therapy. We do not recommend any code
for this procedure other than the associated angioplasty code.

33. Do not report catheter-directed thrombolytic (or non-thrombolytic) infusion therapy
codes for non-catheter-directed peripheral IV infusions. Use code 37195 for intracranial
and 92977 for coronary arterial thrombolysis by peripheral IV infusion (usually via a
large dose infusion of 100 mg tPA).

34. Use code 37195 for intracranial thrombolysis by peripheral intravenous infusion. This is
usually performed in the emergency room by the nurse. Use code 61645 for
catheter-directed cerebral artery infusion for intracranial thrombolysis.

35. Do not use code 37212 for venous infusion thrombolysis of a dialysis shunt. Use code
36904 for this procedure. This code also includes prolonged infusion of any vessel in the
dialysis circuit (e.g., the superior vena cava).

36. If clot extends outside an AV graft into the native central venous system (e.g., subclavian
vein, superior vena cava) and infusion thrombolysis is performed in this area, the
infusion is still bundled, as the central veins are part of the dialysis circuit. Code 36904
includes any and all means to remove thrombus from the dialysis circuit (e.g.,
thrombolysis, lyse and wait, balloon and/or mechanical thrombectomy), even if dialysis
circuit (including central veins) thrombolytic infusion continues overnight.

37. Use code 92977 for coronary arterial thrombolysis by peripheral intravenous infusion.
This is usually performed in the ambulance, emergency room or the physician's office
for a patient with an acute myocardial infarction. Do not use code 92997 for IV infusion
of clot inhibitors such as Angiomax, Integrilin, or ReoPro during coronary intervention.

38. Use code 92975 for coronary arterial thrombolysis by catheter-directed intra-arterial
infusion. Code 92975 is a stand-alone code. Intracoronary arterial thrombolytic infusion
is bundled with coronary angioplasty, atherectomy, and stent placement.

39. Only a catheter placement code should be used for catheter-directed infusion of
Fenoldopam into the kidneys with the Benephit catheter. Fenoldopam is a drug infusion
to prevent nephrotoxicity during contrast angiography. It is a preventative renal therapy,
not a vessel therapy. Use code 36245-50 for catheter placement during bilateral renal
Fenoldopam infusion. Diagnostic renal arteriography should not be coded when used
only as a guiding shot to place the catheters.

40. Intracerebral vasospasm infusion codes 61650 and 61651 are used when drugs such as
papaverine, verapamil, vasopressin, nicardipine, nimodipine, and milrinone are
continuously or intermittently infused intracranially for at least ten minutes. A short
injection of these drugs to treat iatrogenically induced vasospasm is not coded.
Occasionally nitroglycerin is continuously infused overnight using catheter-directed
technique in patients with lower extremity limb threatening ischemia; consider unlisted

code 37799 here. Intravenous (injection or bolus) administration of nitroglycerin is not
considered a non-thrombolytic infusion. Heparin administration is never considered an
infusion therapy. LCDs limit the appropriate indications for infusion therapy.
41. A drug "cocktail" (e.g., verapamil, nitroglycerine, heparin) injected via a radial sheath to
prevent access site vasospasm is not a reportable service. Imaging of this access site is
also not a reportable service.
42. Do not use an interventional code to describe catheter-directed intra-arterial
non-cerebral chemotherapy infusion. Do use code 61650 to describe catheter-directed
intracerebral chemotherapy infusion.
43. The timeline for intracranial infusions requires ten minutes of continuous or
intermittent administration of the medication (e.g., verapamil infusion into the cerebral
vasculature). Infusion therapy in the peripheral system may require hours (e.g., arterial
thrombolysis or vasoconstriction therapy) or days (e.g., venous thrombolysis) to
complete the therapy. Infusion therapy codes 37211 and 37212 specifically do not have
"time required" in the code definitions (however, codes 61650 and 61651 require ten
minutes of continuous or intermittent infusion). Injection or slow push of medication
over one or two minutes is not considered an infusion therapy.
44. Do not submit codes 61645 and 61650 together. Submit either code 61645 or 61650
based on the primary intent of the procedure, but never both for the same cerebral
territory. If both are performed in the same cerebral territory, code 61645 bundles code
61650.
45. Use code 37211 for infusion thrombolytic treatment of a thrombotic complication after
an initial arterial therapeutic intervention (e.g., stent placement) is performed. Use
secondary arterial thrombectomy code 37186 if this thrombotic complication (non-CNS)
is treated separately with percutaneous thrombectomy technique. Intraprocedural
thrombolysis during percutaneous thrombectomy is bundled and is not separately
billable. If primary arterial thrombectomy (37184) is performed, followed by overnight
thrombolytic infusion, add code 37211 or 37212 as appropriate. A separate and distinct
service modifier (e.g., -59, -XU) is necessary.
46. Use code 61645 for treatment of cerebral arterial embolus if a cerebral embolic
complication occurs.
47. Code 75898 applies only to follow-up or completion angiography in conjunction with
CNS and head and neck embolization codes 61624 and 61626. Do not submit with other
embolization codes (37241-37244) or any infusion therapy codes.
48. Do not code for continuing thrombolysis after a catheter check unless this involves an
additional day of therapy. Codes 37213 and 37214 may apply. Follow-up angiography is
bundled, as is catheter exchange. There may be multiple catheter re-checks with stops
and starts of thrombolysis over several days of therapy. Similarly, diagnostic
angiography is only billed once for the entire therapy. Do not submit code 75710 or
75820 again for follow-up extremity arteriography or venography during thrombolysis.
Note that thrombolysis may be intermittantly stopped during prolonged infusions due

to low blood fibrinogen levels. There is no change in coding related to these intermittant
stoppages. Do not use code 37211 or 37212 again just because therapy was restarted
after a few hour "rest" period. Code for each day of therapy.
49. Do not report a diagnostic angiogram code (e.g., 75710, 75820) when a catheter
follow-up thrombolytic angiogram of the leg is performed. This is bundled with codes
37211-37214. Follow-up angiography is bundled with all thrombolytic infusions. Code
75898 is only used for follow-up angiography during neuroembolization procedures (e.g.,
61624, 61626).
50. Codes 61650 and 61651 are billed once per arterial cerebral territory. These territories
are the right and left cerebral vasculature and the posterior fossa when treatment is for
vasospasm or chemotherapy with separate selective catheterizations and infusions.
51. Do not report code 37211 or 37212 for percutaneous thrombectomy of any vessel. Use
percutaneous thrombectomy codes (37184, 37185, 37186, 37187, 37188) for
percutaneous thrombectomy procedures of arteries or veins separate from AV circuit
(36904) and coronary artery (92973). There is an exception for dialysis circuit
thrombolysis ("lyse and wait" technique), which can be billed as an AV circuit
thrombectomy (36904); however, additional methods (Fogarty balloon, AngioJet, etc.)
are usually necessary for successful dialysis graft thrombectomy (these additional
methods are included in the original 36904 thrombectomy code). Use code 36905 or
36906 when AV circuit thrombectomy is performed with angioplasty or stent placement
respectively.
52. If angioplasty or stent placement is performed in conjunction with a thrombolytic
therapy and thrombolytic therapy is continued after the intervention, the thrombolysis
code is based on the day of therapy the infusion is being performed on. Code for each
day of thrombolytic infusion.
53. Do not report codes 37211-37214 for non-catheter-directed intravenous infusions of
heparin, AngioMax, Abciximab (ReoPro), etc.
54. Devices that speed up the thrombolytic process include the ultrasonic vibration device
(EKOS) that disrupts thrombus. This treatment is considered part of the procedure and
may be reported with day one infusion thrombolysis code 37211 or 37212. There is no
additional code for use of the EKOS catheter. Some devices mechanically disrupt the clot
and disperse the intraprocedural thrombolytic agent while removing the residual
thrombus slurry via suction. This may be considered a percutaneous thrombectomy and
not a thrombolysis. Coding for procedures with such a device requires close attention to
the documentation to determine the correct coding.
55. NCCI does not allow submission of code 37211 with 37213 or 37214 on the same date of
service, even if thrombolysis is performed in separate surgical territories, initiating the
thrombolysis on one site a day before the second separate site. The date of service MUE
for these codes is one. Append modifier -50 for non-cerebral bilateral thrombolytic
infusions.
56. Codes 61650 and 61651 bundle vasospasm angioplasty codes 61640-61642.

EXAMPLE(S):

1) 35-year-old presents with right leg pain and lack of distal pulses. Via a contralateral puncture,
a catheter is placed in the right common iliac artery, and diagnostic angiogram of the leg is
performed (75710-59). An occlusion consistent with an embolus is seen in the superficial
femoral artery. An infusion catheter is placed across the occlusion (36247), and infusion of
thrombolytic agent is started (37211). Infusion is continued overnight into the morning.
Follow-up angiography is performed. The clot fragments and is lodged at the posterior tibial
artery. The old infusion catheter is removed, and new longer infusion catheter is placed
(included with code 37213). Thrombolytic infusion is continued for another six hours. Follow-up
angiography (bundled) at this point shows a patent tibial vessel but 80% stenosis of the distal
external iliac artery. This is treated with primary stent placement (37221). Follow-up
angiography shows a new thrombus in the anterior tibial artery (no code). A cross-over sheath is
placed, and suction embolectomy (37186) is performed. Follow-up angiography shows patency
(no code).

2) 30-year-old woman presents with bilateral leg swelling with deep vein thrombosis seen on
ultrasound. Ultrasound-guided puncture of both popliteal veins (do not report code 76937
without hard copy image documentation) with placement of sheaths, followed by diagnostic
venography (75822-59), shows the extensive clot. Initial percutaneous venous thrombectomy is
performed in both right and left leg deep venous systems (37187-50). Two long infusion
catheters are then advanced to the inferior vena cava (36010-50), and thrombolytic infusions
are started (37212-5950). Infusion is continued for twenty-four hours (37213-50). Follow-up
imaging (bundled) shows continued clot requiring repeat bilateral percutaneous venous
thrombectomy (37188-50). This shows resolution of the clot bilaterally with underlying stenosis
of the left common iliac vein, but no stenosis on the right. A primary left iliac vein stent (37238)
is placed (add 37214-50, as the second day of therapy turned out to be the last day of therapy;
delete 37213-50).

Note: Codes 37211 and 37212 are reimbursed as a bilateral procedure when reported with a
-50 modifier appended (or modifiers -LT/-RT). Codes 37213 and 37214 will not. Only one
procedure will be reimbursed.

3) 58-year-old critically ill patient with dyspnea and suspected pulmonary embolus. A catheter is
placed in the main pulmonary artery (36013), and non-selective pulmonary angiogram (75746)
shows a large saddle embolus. An infusion catheter is placed after initial attempts at breaking
up the clot were done with an AngioJet thrombectomy device (37184). High dose infusion
thrombolysis (37211-59) is then performed over two hours. Follow-up angiography (bundled)
shows improvement. The patient is much less symptomatic.

Note: Pulmonary artery thrombectomy remains a non-covered service for Medicare, as it is
considered experimental. Please refer to NCD #240.6. Add -GZ modifier to code 37184 in this
circumstance if Medicare is the payer.

4) Same case as example #3, except after non-selective pulmonary angiography (75746), a
catheter is placed in the right lower lobe pulmonary artery (36015), and thrombolysis is started

(37211). A second access is obtained, and a second catheter is advanced into the left upper lobe
(36015). Thrombolysis is also started at this site (add -50 modifier to 37211). Follow-up
angiography is done through each catheter after three hour infusions (bundled).

Note: Since this patient is an inpatient, modifiers are not necessary for hospital billing.
Physicians should apply appropriate modifiers. The right and left lungs represent two surgical
treatment fields, and since they are treated by two separate catheters, infusion treatment is
coded twice. If both lungs are treated by a single central infusion catheter, only code one
thrombolysis.

5) 40-year-old male smoker with ischemic digits after cold exposure (Raynaud's phenomenon)
undergoes a left upper extremity angiogram. Via a transfemoral approach, arch angiography
(36221) followed by selective left upper extremity angiogram (75710) from the subclavian level
(36215) shows slow flow but no large vessel stenosis. A bolus of 25 mg Priscoline is given (no
code; do not use 37799) followed by repeat angiography (no code), showing no stenosis distally.
Cold water immersion (no code) shows vasospastic digital vessels.

6) 68-year-old with right colonic bleeding undergoes diagnostic aortography (included in visceral
angiography), selective superior mesenteric angiography (75726, 36245), and selective inferior
mesenteric angiography (75726-59, 36245-59). This shows a right-sided diverticular bleed.
Selective infusion catheter placement in the superior mesenteric artery and infusion of
vasopressin (consider 37799) at 0.2 units/minute is started for induction of vasoconstriction.
After two hours infusion time, she develops acute chest pain, which resolves promptly after
stopping the vasopressin infusion. Follow-up angiography shows continued bleeding (no code) in
a right colic branch. This is selected (add 36247, delete 36245) and embolized with two 2 mm
coils (37244). Follow-up angiography after embolization (bundled) shows cessation of bleeding.

7)27-year-old with cerebral vasospasm related to subarachnoid hemorrhage from a ruptured
aneurysm is treated by catheter-directed infusion therapy with verapamil (nicardipine,
nimodipine, milrinone, or papaverine). The catheter is placed sequentially in the right internal
carotid artery, left internal carotid artery, and the left vertebral artery to treat these separate
cerebral territories for vasospasm (61650, 61651 x 2). Each treatment is for 10-20 minutes per
vessel. Follow-up angiography (bundled) is performed in each vessel treated.

Note: If diagnostic angiography is documented prior to the infusion therapy, imaging and
catheter placement are bundled for ipsilateral treated vessels. Use cervicocerebral codes
36222-36228 to describe vessels selected, imaged, and not treated by infusion therapy. The
catheter placement codes are bundled. Use of vasospasm angioplasty codes (61640, 61641, and
61642) is not allowed in the same vessels/same session as intracranial vasospasm infusion
therapy codes 61650 and 61651. Do not use code 61645 at the same session/same territory as
codes 61650 and 61651 when the primary intent of treatment is for vasospasm.

PERCUTANEOUS THROMBECTOMY

Percutaneous Thrombectomy

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
Thrombectomy refers to the removal of blood clot from a vascular structure. This may be
performed in an artery or a vein. Different techniques have been used, with the most common
being an open incision and removal of the clot by placing a Fogarty balloon (non-inflated)
beyond the clot, inflating the balloon, and pulling back the balloon (and clot) out of the incision.
This technique is usually performed by the vascular surgeon in the operating room.
Percutaneous techniques have been employed in dialysis grafts and consist of maceration
technique, push and pull technique with Fogarty balloons, suction embolectomy with a sheath,
and more commonly the use of a dedicated thrombectomy device or catheter that disrupts,
fragments, and/or removes the clot by suction. Codes are available for percutaneous
thrombectomy performed in the vascular system (arteries or veins), which differ from codes
currently used for percutaneous dialysis graft and coronary arterial thrombectomy. After
removal of the clot, an underlying blockage is often found. The percutaneous disruption,
fragmentation, and/or removal of thrombus is an adjunctive therapy to an angioplasty or stent
placement, which may be required to treat an underlying stenosis. Primary thrombectomy can
also be a stand-alone procedure in the non-coronary system, but is an add-on code in the
coronary arteries.

CLINICAL INDICATIONS:
Known acute or chronic occlusion of a vessel or graft due to thrombus or embolus,
claudication, rest pain, stroke, ischemia, swollen extremity (deep vein thrombosis),
mesenteric venous thrombosis, and embolic or thrombotic complication of an intervention.

CODES: T
PROCEDURE DESCRIPTION O
A T
PROC CODE P A S&I CODE
C
L
R

V

Primary percutaneous transluminal mechanical thrombectomy, 37184 5 1 Bundled
noncoronary, non-intracranial, arterial or arterial bypass graft, 1 3
including fluoroscopic guidance and intraprocedural 9 .
pharmacological thrombolytic injection(s); initial vessel 2 0
9

Primary percutaneous transluminal mechanical thrombectomy, N 4 Bundled
noncoronary, non-intracranial, arterial or arterial bypass graft, / .
including fluoroscopic guidance and intraprocedural A 9
pharmacological thrombolytic injection(s); second and all 0
subsequent vessel(s) within the same vascular family (List 37185
separately in addition to code for primary mechanical 37186 N 7 Bundled
thrombectomy procedure) / .
Secondary percutaneous transluminal thrombectomy (eg, A 1
nonprimary mechanical, snare basket, suction technique), 4
noncoronary, non-intracranial, arterial or arterial bypass graft,
including fluoroscopic guidance and intraprocedural
pharmacological thrombolytic injections, provided in conjunction
with another percutaneous intervention other than primary
mechanical thrombectomy (List separately in addition to code for
primary procedure)

Percutaneous transluminal mechanical thrombectomy, vein(s), 37187 5 1 Bundled
including intraprocedural pharmacological thrombolytic injections 1 1
and fluoroscopic guidance 9 .
2 4
2

Percutaneous transluminal mechanical thrombectomy, vein(s), 58
including intraprocedural pharmacological thrombolytic injections 1 .
and fluoroscopic guidance, repeat treatment on subsequent day 37188 8 1 Bundled
during course of thrombolytic therapy
33

Percutaneous transluminal mechanical thrombectomy and/or 36904 5 1 Bundled
infusion for thrombolysis, dialysis circuit, any method, including all 1 0
imaging and radiological supervision and interpretation, diagnostic 9 .
angiography, fluoroscopic guidance, catheter placement(s), and 2 7
intraprocedural pharmacological thrombolytic injection(s); 8

Percutaneous transluminal mechanical thrombectomy and/or 51
infusion for thrombolysis, dialysis circuit, any method, including all 1 2
imaging and radiological supervision and interpretation, diagnostic 36905 9 . Bundled
angiography, fluoroscopic guidance, catheter placement(s), and
39

intraprocedural pharmacological thrombolytic injection(s); with 4
transluminal balloon angioplasty, peripheral dialysis segment,
including all imaging and radiological supervision and
interpretation necessary to perform the angioplasty

Percutaneous transluminal mechanical thrombectomy and/or 36906 5 1 Bundled
infusion for thrombolysis, dialysis circuit, any method, including all 1 4
imaging and radiological supervision and interpretation, diagnostic 9 .
angiography, fluoroscopic guidance, catheter placement(s), and 4 9
intraprocedural pharmacological thrombolytic injection(s); with 5
transcatheter placement of intravascular stent(s), peripheral
dialysis segment, including all imaging and radiological supervision
and interpretation necessary to perform the stenting, and all
angioplasty within the peripheral dialysis circuit

Percutaneous arterial transluminal mechanical thrombectomy ♦ 61645 2
and/or infusion for thrombolysis, intracranial, any method, N4
including diagnostic angiography, fluoroscopic guidance, catheter / . Bundled
placement, and intraprocedural pharmacological thrombolytic A0
injection(s)
4

Percutaneous transluminal coronary thrombectomy mechanical N 5 Bundled
(List separately in addition to code for primary procedure) / .
A 1
5
92973

♦ Inpatient-Only Procedure Add-on Code

CODING INSTRUCTIONS:
57. For percutaneous thrombectomy performed in non-coronary, non-cerebral arteries, use
codes 37184, 37185, and 37186. When performed in coronary arteries, use code 92973.
When performed in cerebral arteries, use code 61645. When performed in the dialysis
circuit, use codes 36904-36906. When performed in veins, use codes 37187 and 37188.
58. Do not use arterial codes 37184-37186 for thrombectomy of the arteries of the brain.
Use code 61645 to describe cerebral artery embolus/thrombus treatment per territory
treated.

59. Thrombectomy codes are based on surgical sites treated (e.g., right leg, left leg).
Bilateral primary arterial thrombectomy at the same session is reported with code
37184-50. If thrombectomy is on the same leg, different vessels (e.g., right leg SFA, right
leg tibial), use codes 37184 and 37185.

60. Do not use code 36904 for peripheral or visceral arterial or venous thrombectomy. Use
code 36904 for percutaneous thrombectomy of dialysis graft or fistula, usually of the
arm or leg. This includes "lyse and wait" technique. Codes 36905 and 36906 describe
dialysis graft thrombectomy with peripheral segment angioplasty or stent placement
respectively.

61. Do not use codes 37184-37187 or 37212-37214 for thrombectomy or thrombolysis
(respectively) of the dialysis circuit, as codes 36904-36906 describe "declot by any
method" of the entire dialysis circuit, including both the peripheral and central
segments.

62. Do not use code 92973 for peripheral or visceral arterial or venous thrombectomy. Use
code 92973 for percutaneous mechanical arterial thrombectomy of coronary arteries.
Code 92973 is an add-on code to diagnostic heart catheterizations, coronary artery
angioplasty, atherectomy, and stent placement. Code 92973 is not used when
"aspiration" thrombectomy catheters are utilized.

63. Do not use code 37211 or 37212 for thrombolysis performed during thrombectomy.
Intraprocedural thrombolysis is bundled into the thrombectomy codes. This includes "a
little" thrombolysis before and after the thrombectomy.

64. Use code 37211 or 37212 for extended catheter-directed arterial or venous
thrombolysis performed before or after thrombectomy (this must be a prolonged
catheter-directed infusion, not just a preliminary "lacing" or follow-up pulse spray).

65. Code 37211 is not used for cerebral artery thrombolysis. Use code 61645 for treatment
of cerebral arterial thrombus by any method (e.g., thrombolysis, thrombectomy). Do
use code 37212 for catheter-directed cerebral venous thrombolysis and code 37187 for
initial day of cerebral venous thrombectomy if performed.

66. Code for diagnostic angiography prior to non-intracranial arterial thrombectomy (if no
prior exam).

67. Cerebral artery thrombectomy code 61645 bundles ipsilateral catheter placement,
diagnostic imaging, thrombolysis, intracerebral balloon angioplasty and/or stent
placement, vasospasm infusion therapy, and follow-up imaging.

68. Do not submit code 61630 or 61635 for cerebral angioplasty or stent placement in the
same cerebral territory as code 61645.

69. Code for other interventions performed after non-cerebral clot removal (angioplasty,
atherectomy, stent placement).

70. Do not code follow-up or intraprocedural angiography, as these are bundled with
percutaneous thrombectomy codes.

71. Code for selective catheter placements, unless the thrombectomy is in conjunction with

lower extremity or cerebral arterial endovascular revascularization. In this case, the
catheter placements are bundled at the same session as the revascularization
procedure.
72. Do not report open surgical thrombectomy codes when the procedure is performed
percutaneously.
73. Do not report percutaneous thrombectomy codes when an open surgical thrombectomy
is performed.
74. Primary percutaneous arterial thrombectomy (37184) refers to performing non-cerebral
arterial thrombectomy as your planned initial treatment (separate from diagnostic
angiography). Treatment with percutaneous thrombectomy of a a totally thrombosed
and occluded fem-pop bypass graft would be a good example for use of code 37184.
75. Many devices are available for limited or extensive non-coronary arterial and venous
thrombectomy procedures. Use the arterial thrombectomy code based on "primary" vs.
"secondary" thrombectomy indications and extent of thrombus.
76. It is appropriate to use primary thrombectomy codes 37184 and 37185 if a subsequent
intervention (stent placement) is performed after percutaneous thrombectomy.
77. Additional arterial vessel thrombectomy (37185) refers to treatment of thrombus in a
separate and distinct vessel from the initially treated vessel, but in the same vascular
family. Commonly, this will be a vessel distal to the originally treated vessel (e.g., the
anterior tibial artery after a fem-pop bypass graft thrombectomy). This is an add-on
code to 37184. Code 37185 is used only once in the same vascular family, even if several
distal branches are selected and treated. The superficial femoral and popliteal arteries
are considered two vessels in the same vascular family, and thrombectomy involving
both of these vessels is described by codes 37184 and 37185 (different than
revascularization codes 37224-37227, which bundle the SFA and popliteal into a single
territory).
78. For cerebral arterial thrombectomy (61645), all therapy in one cerebral territory is
included in this single code. If a separate territory (there are three territories total) is
also treated, add another 61645.
79. Secondary percutaneous arterial thrombectomy (37186) refers to arterial
thrombectomy when not initially planned. This would be utilized when an angioplasty or
stent placement is performed and completion angiography shows an occluded distal
vessel, requiring limited catheter thrombectomy, snare capture and removal, or suction
removal of clot. This code may also be utilized when there is a short occlusion with clot
noted prior to intervention requiring a "quick" thrombectomy to allow the intended
angioplasty or stent placement. Accurate physician documentation is mandatory to
appropriately code these procedures.
80. Do not use codes 37184 and 37186 together, as the thrombectomy procedure is either
primary or secondary in nature. "Chasing" arterial clot into a distal vessel utilizes
additional vessel thrombectomy code 37185.

81. Do not use code 37186(secondary arterial thrombectomy) when a primary
thrombectomy (37184, 37185) is performed.

82. Venous thrombectomy codes 37187 and 37188 are used for treatment (usually to
debulk clot in a large vein) on the initial date of therapy and on each subsequent date,
respectively. These venous codes can be used in any vein, including the cerebral venous
system. Only use these codes once per day per vascular territory when ongoing
thrombolysis is performed. Code 37187 is only used on the initial date of thrombectomy
service. Code 37188 is used once on each subsequent day. If two vascular distributions
are involved with separate treatment catheters (e.g., both legs), report code 37187 or
37188 twice (or one time with a -50 modifier).

83. Use percutaneous arterial thrombectomy codes only once per vessel (or territory in the
case of cerebral arteries) treated, no matter how many different techniques or
catheters are used to perform the thrombectomy. If a second artery in the same surgical
site (e.g., lower extremity) is treated with thrombectomy, use code 37185 once (even if
multiple additional arteries are treated). Code 61645 includes the initial vessel and all
additional vessels treated in the same cerebral territory. There is no "additional"
cerebral revascularization code.

84. Balloon maceration of clot is not an angioplasty, but may be an adjunct to a
thrombectomy to make it easier to remove the clot by other thrombectomy techniques.
Use of the angioplasty codes require documentation of an underlying hemodynamically
significant stenosis.

85. Arterial thrombectomy codes 37184-37186 can be used to remove clot in any
non-coronary, non-cerebral artery.

86. Arterial thrombectomy codes (37184-37186) also apply to pulmonary artery
thrombectomy; however, per NCD 240.6, percutaneous pulmonary artery
thrombectomy is a non-covered service for Medicare patients. Consider adding a -GZ
modifier to indicate this.

87. The venous thrombectomy codes can be used to remove clot in any vein other than AV
shunts. This would include legs, arms, IVC, SVC, mesenteric, portal, jugular, or
intracranial veins. These are "day of therapy" codes. If the patient returns for an
additional thrombectomy in the same surgical territory later on the same date of service,
there is no additional code for this repeat service. Use code 37188 if done on a
subsequent day (after midnight).

88. Do not code fluoroscopy (76000) with any of the percutaneous thrombectomy codes.
89. Conscious sedation (99151-99157) may be separately reported with percutaneous

thrombectomy procedures.
90. Code primary percutaneous arterial thrombectomy (37184) for non-cerebral arterial clot

removal procedures performed after initial thrombolysis.
91. Code secondary percutaneous arterial thrombectomy (37186) as a "bail-out" or rescue

therapy after a non-cerebral arterial endovascular intervention.

92. All ongoing, guiding, and follow-up angiography during thrombectomy is bundled.
93. Do not use code 75898 or repeat angiography as a "completion exam" for percutaneous

thrombectomy, as follow-up imaging is bundled.
94. Do not use code 75898 for follow-up after ongoing catheter-directed thrombolytic

infusion (37211-37214), as follow-up imaging is bundled.
95. Do not report codes 37184-37188 for declot of an AV dialysis circuit. Use codes

36904-39606 instead.
96. Some devices disrupt the clot and help distribute a thrombolytic agent to a larger

surface area of thrombus to increase the efficiency of clot dissolution. This slurry of
partial thrombus may be aspirated and removed from the body. Depending on the
documentation and the way the device is utilized, it may be considered a thrombectomy
or a thrombolysis. Be sure to discuss this with the performing physician.
97. The Pathway Jetstream G3® device can be utilized as either a thrombectomy device or
an atherectomy device. Attention to documentation is necessary to differentiate and bill
the appropriate codes, as the procedure performed is usually one or the other, but not
both.

EXAMPLE(S):

1) 49-year-old patient with cold left leg and occluded left fem-pop bypass graft on Doppler.
Puncture of the right common femoral artery with placement of a sheath and subsequently a
catheter into the aorta. Aortogram is performed (75625). The catheter is advanced over the
bifurcation to the left iliac, and unilateral left leg angiogram is performed (75710-59). Catheter
is advanced into the occluded graft (36247), exchange is made for an Oasis thrombectomy
device, and thrombectomy is performed (37184). Intra-procedural pulse spray thrombolysis is
also used (no code). The catheter is then advanced into the tibial/peroneal trunk where further
thrombectomy is performed (37185). Underlying stenosis of the distal anastomosis is treated
with a nitinol stent (add 37226; delete 36247, as bundled with stent placement at the same
session). Persistent clot in the tibial/peroneal trunk is seen on follow-up angiogram (no code),
which is then treated with infusion thrombolysis (37211-59) over four hours. Follow-up
angiography (bundled) shows clearing of clot but underlying 90% stenosis of the tibial/peroneal
trunk, treated with a Diamondback Orbital atherectomy catheter (37229), and 80% stenosis of
the anterior tibial artery, treated with balloon angioplasty (37232 - the tibial/peroneal trunk
and anterior tibial arteries are considered two separate vessels for coding in this example; code
for the highest level of intervention, the atherectomy, as the initial tibial/peroneal intervention
and the anterior tibial angioplasty as the additional intervention). Follow-up angiography shows
excellent results (no code).

2) Patient with known left external iliac stenosis presents for iliac stent. Sheath is placed in the
right femoral artery, and a catheter is advanced into the left common iliac artery. Angiography
is performed (no code, as already had a diagnostic angiogram and this was for "confirmation of
stenosis and sizing of vessel"). The vessel measured 7 mm. The 7 mm balloon-expandable stent
is placed (37221) after preliminary angioplasty with a 7 mm balloon (bundled with the stent

procedure). Follow-up angiography (no code) shows occlusion of the profunda femoral artery.
Using snare technique, clot and embolus are removed (37186) from this vessel (catheter
placement in the third order profunda femoral is bundled with stent placed in the same vascular
family). Follow-up angiography shows patency (no code).

3) Via a popliteal approach, a catheter is advanced through an occluded femoral/popliteal
saphenous vein arterial bypass graft (bundled with stent placement at same setting), and
primary thrombectomy is performed (37184). Stent placement across a stenotic valve in the
mid-graft is performed (37226). Follow-up shows thrombosis of the entire graft. This is treated
with repeat thrombectomy including intraprocedural thrombolysis (no code) with excellent
results. The catheter is removed, and a Boomerang device is used for hemostasis (bundled with
stent placement in the lower extremities).

4) Same patient as #3, however, via a contralateral femoral access, thrombectomy (37184) of
the femoral/popliteal saphenous vein arterial bypass graft shows a large pseudoaneurysm
(without stenosis) at the proximal vein graft anastomosis. A covered stent graft is placed across
this to treat the pseudoaneurysm (36247, 37236).

Note: Do not use code 37226, as the stent graft was not placed for occlusive disease. It was
placed for treatment of a pseudoaneurysm.

5) 31-year-old female with left leg deep vein thrombosis. Via popliteal vein puncture, a sheath is
placed and venography performed (75820-59). An IVUS catheter is advanced into the IVC
(36010). IVUS pullback from the IVC is done, showing 80% stenosis of the common iliac vein
(37252). A thrombectomy device is advanced through the clot and all the way into the IVC to
debulk the thrombus (37187). Prolonged catheter-directed infusion thrombolysis (37212) is
started. Follow-up angiography the next day (bundled with 37213) shows partial resolution of
clot, but repeat thrombectomy of the IVC is necessary (37188). Catheter exchange to a longer
catheter into the IVC (bundled with 37213) is done, and thrombolysis is continued. Follow-up on
the third day shows stenosis in the iliac vein (bundled) treated with a stent (37238). The sheath
is removed (included with 37214, cessation of therapy).

Transcatheter Embolization



7 Vascular Interventional Coding
Transcatheter Embolization Pages: 239-250

Procedure Example(s)
Clinical Indications Grey Zone Discussion
Codes References
Coding Instructions

PROCEDURE:
Embolization procedures may require that a diagnostic angiogram be performed prior to
selective embolization. Once an abnormality has been evaluated with blood supply and venous
shunting determined, selective or superselective catheterization is performed utilizing standard
or microcatheters. Once the catheter tip is ideally positioned to prevent non-target vessel
complications, injection or placement of embolic material (autologous blood clot, gelfoam,
polyvinyl alcohol, micro-spheres, theraspheres, sirspheres, coils, glue, or balloons) into the
selected vessel(s) is performed via the catheter. The intent is to block the blood vessel(s)
supplying the abnormality. This can be performed in all four vascular systems (arterial, venous,
pulmonary, and portal), along with the lymphatic system. Once an embolization procedure is
concluded, a completion angiogram is performed to demonstrate success. These percutaneous
(usually transcatheter) procedures allow a minimally invasive technique to treat very
complicated abnormalities with very low complications. Non-neuro embolization codes apply to
arterial, venous, and lymphatic structures and are based on the clinical indication and
abnormality being treated (venous vascular/lymphatic abnormality, arterial vascular
abnormality, tissue ablation/organ infarction, and hemmorhage). Other codes and guidelines
are pertinent to CNS and head and neck embolizations.

CLINICAL INDICATIONS:
Treatment of aneurysms (not primary endovascular therapy for aortic or iliac aneurysms),
pseudoaneurysms, arteriovenous malformations, lymphatic malformations, cystic hygromas,
arterial to venous fistulae (cavernous-carotid fistula after trauma, pulmonary arterial fistulae
in Osler-Webber-Rendu syndrome), benign (uterine fibroids) or malignant vascular neoplasms,
sites of bleeding (varices, ulcers, diverticula, postpartum hemorrhage, bronchial bleeding
from tumor, cystic fibrosis or granulomatous disease, post surgical sites, puncture site
pseudoaneurysm, trauma such as liver biopsy, gun shot, stab wound, thoracic duct
transection, etc.), infertility (varicocele embolization), thoracic duct injury, chylous effusion,
residual aortic aneurysm sacs in patients already treated with stent grafts or surgery, and
non-target vessel occlusion prior to other planned procedures (e.g., Y-90 treatment).

CODES: PROC TS A TOTAL
PROCEDURE DESCRIPTION CODE O& P RVU
AT I C
P AL C
CR O
VD
UE

Injection procedures (eg, thrombin) for percutaneous 36002 5 7 N
treatment of extremity pseudoaneurysm 1 3. 6 / 0.92
8 07 9 A
1 4
2

Dialysis circuit permanent vascular embolization or occlusion N 6. B
(including main circuit or any accessory veins), endovascular, / 04 u
including all imaging and radiological supervision and A n
interpretation necessary to complete the intervention (List dl
separately in addition to code for primary procedure) 36909 e
d

Transcatheter placement of an intravascular stent(s) (except 37236 5 13 B
lower extremity artery(s) for occlusive disease, cervical carotid, 1 .0 u
extracranial vertebral or intrathoracic carotid, intracranial, or 9 0 n
coronary), open or percutaneous, including radiological 3 dl
supervision and interpretation and including all angioplasty e
within the same vessel, when performed; initial artery d

Vascular embolization or occlusion, inclusive of all radiological 37241 5 12 B
supervision and interpretation, intraprocedural roadmapping, 1 .9 u
and imaging guidance necessary to complete the intervention; 9 1 n
venous, other than hemorrhage (eg, congenital or acquired 3 dl
venous malformations, venous and capillary hemangiomas, e
varices, varicoceles) d

Vascular embolization or occlusion, inclusive of all radiological 37242 5 13 B
supervision and interpretation, intraprocedural roadmapping, 1 .9 u
and imaging guidance necessary to complete the intervention; 95 n

arterial, other than hemorrhage or tumor (eg, congenital or 3 dl
acquired arterial malformations, arteriovenous malformations, e
arteriovenous fistulas, aneurysms, pseudoaneurysms) d

Vascular embolization or occlusion, inclusive of all radiological 37243 5 16 B
supervision and interpretation, intraprocedural roadmapping, 1 .3 u
and imaging guidance necessary to complete the intervention; 9 8 n
for tumors, organ ischemia, or infarction 3 dl
e
d

Vascular embolization or occlusion, inclusive of all radiological 37244 5 19 B
supervision and interpretation, intraprocedural roadmapping, 1 .3 u
and imaging guidance necessary to complete the intervention; 9 7 n
for arterial or venous hemorrhage or lymphatic extravasation 3 dl
e
d

Endovascular temporary balloon arterial occlusion, head or 61623 5 16 B
neck (extracranial/intracranial) including selective 1 .8 u
catheterization of vessel to be occluded, positioning and 9 0 n
inflation of occlusion balloon, concomitant neurological 3 dl
monitoring, and radiologic supervision and interpretation of all e
angiography required for balloon occlusion and to exclude d
vascular injury post occlusion

Transcatheter permanent occlusion or embolization (eg, for ♦ 61624 N 33 7 N
tumor destruction, to achieve hemostasis, to occlude a / .5 5 / 2.05
vascular malformation), percutaneous, any method; central A8 8 A
nervous system (intracranial, spinal cord) 9
4

Transcatheter permanent occlusion or embolization (eg, for 61626 5 25 7 N
tumor destruction, to achieve hemostasis, to occlude a 1 .1 5 / 2.05
vascular malformation), percutaneous, any method; 9 9 8 A
non-central nervous system, head or neck (extracranial, 3 9
brachiocephalic branch) 4

Angiography through existing catheter for follow-up study for 7 5
transcatheter therapy, embolization or infusion, other than for 5 1
thrombolysis 8 8 2.56
9
8 2

Ultrasound guided compression repair of arterial 7 5 2.78
pseudoaneurysm or arteriovenous fistulae (includes diagnostic 6 7

ultrasound evaluation, compression of lesion and imaging) 92
32
6

Endovascular repair of iliac artery by deployment of an ilio-iliac ♦ 34707 N 33 B
tube endograft including pre-procedure sizing and device / .3 u
selection, all nonselective catheterization(s), all associated A1 n
radiological supervision and interpretation, and all endograft dl
extension(s) proximally to the aortic bifurcation and distally to e
the iliac bifurcation, and treatment zone angioplasty/stenting, d
when performed, unilateral; for other than rupture (eg, for
aneurysm, pseudoaneurysm, dissection, arteriovenous
malformation)

Endovascular repair of iliac artery by deployment of an ilio-iliac ♦ 34708 N 53 B
tube endograft including pre-procedure sizing and device / .6 u
selection, all nonselective catheterization(s), all associated A1 n
radiological supervision and interpretation, and all endograft dl
extension(s) proximally to the aortic bifurcation and distally to e
the iliac bifurcation, and treatment zone angioplasty/stenting, d
when performed, unilateral; for rupture including temporary
aortic and/or iliac balloon occlusion, when performed (eg, for
aneurysm, pseudoaneurysm, dissection, arteriovenous
malformation, traumatic disruption)

Endovascular repair of iliac artery bifurcation (eg, aneurysm, ♦ 0254T N 0. B
pseudoaneurysm, arteriovenous malformation, trauma, / 00 u
dissection) using bifurcated endograft from the common iliac A n
artery into both the external and internal iliac artery, including dl
all selective and/or nonselective catheterization(s) required for e
device placement and all associated radiological supervision d
and interpretation, unilateral

♦ Inpatient-Only Procedure Add-on Code

CODING INSTRUCTIONS:
Peripheral and Visceral Embolization Guidelines

98. A series of codes (37241-37244) and guidelines have been established for embolizations.
These codes are based on the abnormality being treated (e.g., vascular malformation,

tumor, hemorrhage, etc.) and are specific to non-head and neck and non-CNS
embolizations. Use CNS and head and neck embolization codes and guidelines for these
neurointerventions (61624, 61626, 75894, and 75898).
99. Embolization codes (37241-37244) allow separate reporting of selective catheter
placements and associated diagnostic imaging. Do not code for guiding shots or post
embolization completion angiography with these codes.
100. Code 37241 describes embolization to treat venous vascular abnormalities other than
those due to lower extremity venous insufficiency. This code can be used for treatment
of non-hemorrhaging esophageal or visceral varices due to portal hypertension
[obliteration of varices with coils (CARTO: coil assisted retrograde transvenous
obliteration), plugs (PARTO), balloon occlusion retrograde (BRTO) and balloon occlusion
antegrade (BATO), sclerosant administration], varicoceles, pelvis venous congestion
syndrome, and venous malformations (e.g., Klippel-Trenaunay syndrome, hemangiomas)
by selective catheterization or direct access technique. This code also describes
embolization of a venous abnormality (hemangioma) via a transcatheter arterial
approach and percutaneous treatment of lymphatic malformations.
101. Add-on code 36909 describes occlusion of competitive venous branches of a
non-maturing AV fistula. Do not use code 37241 for this procedure. Selective venous
catheter placements in these venous branches are bundled with code 36909.
102. Use venous embolization code 37241 for micro- or macrocytic lymphatic malformation
treatment with direct access technique and alcohol or other medication injection. This
procedure is best described by code 37241 and was the original intent of the code. The
direct vascular access is included (non-selective catheterization is not reported).
103. Code 37242 describes embolization of arterial abnormalities such as AVMs, aneurysms,
pseudoaneurysms, and AV fistulae. (Use code 36002 to describe pseudoaneurysm
treatment via direct puncture for thrombin injection, along with ultrasound guidance
code 76942.) Code 37242 also applies to proximal non-target vessel embolization
(usually with coils) to prevent reflux embolization during the subsequent intended
therapeutic embolization (e.g., Y-90 or TACE for hepatic tumor embolization).
Non-target vessel embolization here can only be reported when performed at a prior
session. Non-target vessel embolization of an IMA, internal iliac, or accessory renal is
reported at the same session as an EVAR or iliac aneurysm endograft repair.
104. Code 37243 describes embolization that causes tissue necrosis or infarction of the
intended organ (e.g., renal infarction for severe proteinuria, benign prostatic
hypertrophy (BPH), fibroids, renal cell carcinoma, hepatic or osseous metastasis). This
includes treatment of benign or malignant vascular neoplasms/tumors, splenic
hypertrophy, and selective portal vein embolization pre-operatively to shrink a lobe of
the liver that contains tumor.
105. Code 37244 describes embolization for treatment of vascular or lymphatic hemorrhage
or extravasation. Examples include active esophageal hemorrhage, GI bleeding,
bronchial bleeding, post partum hemorrhage, thoracic duct leak, post biopsy bleeding,

trauma, and post-operative bleeding.
106. When a stent is used as a lattice to facilitate a peripheral or visceral embolization

procedure (e.g., wide-mouthed aneurysm), only report the CPT code for the
embolization (e.g., 37242). When a covered stent is used as the sole treatment (e.g.,
stent for venous rupture, covered stent for gunshot wound to subclavian artery), report
the appropriate stent code (37238 or 37236, respectively) instead of code 37244. If both
coils and a stent are placed to embolize a single site, only submit the appropriate
embolization code (37241-37244), not a stent code.
107. Code the embolization based on "immediate" medical necessity (e.g., report code
37244 when embolizing an actively bleeding tumor, not 37243).
108. Codes 37241-37244 are reported per surgical field treated, not per vessel treated. An
entire extremity is considered a surgical field.
109. Code two embolization procedures (37241 x 2) if bilateral varicocele venous
embolizations are performed in the male.
110. Code for two embolization procedures (37241 x 2) if both the pelvic veins and the
central veins (proximal ovarian veins near the level of the renal veins) are embolized for
complex pelvic venous congestion syndrome.
111. If only one side is embolized for treatment of varicocele or pelvic venous congestion
syndrome, only code one embolization procedure (37241). Code all diagnostic
venography and catheter placements as documented.
112. Only submit one embolization code (37241-37244) per surgical site. If the GDA is
embolized to prevent reflux at the same session as a Y-90 treatment of hepatic
metastasis or hepatocellular carcinoma, only submit code 37243, as this code includes
non-target embolization at the same session. If the GDA is prophylactically embolized
during the diagnostic angiogram to prevent non-target vessel complication (prior to a
Y-90 treatment that is to be performed on a subsequent date of service), use code
37242. If both the GDA and right gastric arteries are embolized at this session, only one
embolization is coded, as the embolization of multiple non-target vessels is for
pre-treatment of one surgical site.
113. Code 79445 can be submitted when a radioisotope such as Y-90 is administered during
the embolization procedure. Other radiation therapy codes are also applicable by the
hospital and authorized user (e.g., for handling and measuring the amount of
radioisotope).
114. Use code 96420 when chemotherapy is given as part of an embolization procedure per
the CPT Codebook. Per CMS, in the NCCI Manual (version 24.0), physicians should not
report code 96420 in the facility setting. They should only report it if performed in the
physician office. Hospitals may report code 96420 separately for the "chemo" portion of
a chemoembolization.
115. Do not code MAA (nuclear medicine agent) injection for yttrium-90 work-up. This
portion of the exam is not an embolization, rather it is part of the nuclear medicine

exam. Do not use code 37243 for this. Do code for the nuclear medicine imaging
procedure (e.g., initial diagnostic lung perfusion scan, liver scan). If a separate coil
embolization is performed at this session to prevent reflux complications during future
Y-90 treatment (e.g., right gastric, gastroduodenal arteries), report code 37242, unless
Y-90 embolization is performed at the same session. Do not report nuclear medicine
imaging codes when imaging of the lungs or liver is done after the Y-90 treatment. This
is considered incidental imaging.
116. Do code separately for selective catheter placements during all embolization
procedures described by codes 37241-37244. Do not report non-selective catheter
placements during these embolizations.
117. Code for diagnostic angiography that is medically necessary for evaluation of the
abnormality prior to embolization. Add modifier -59 to true diagnostic angiography at
the time of embolizations.
118. Do not report codes for guiding shots, roadmapping, or S&I (75894) with codes
37241-37244. Guiding shots and S&I are bundled with these codes.
119. Do not report code 75898 with codes 37241-37244. Follow-up angiography is bundled
with these codes.
120. Use code 37243 to describe uterine embolization for treatment of fibroids. This
procedure includes guiding shots, follow-up imaging and embolization of all vessels
(including ovarian arteries) supplying (or potentially supplying) the uterine fibroids. The
catheter placement codes are separately reported.
121. Use code 37243 to describe embolization for treatment of benign prostatic
hypertrophy (BPH). This is similar to fibroid embolization and is used to "shrink" the
overall size of the prostate in men with urinary retention symptoms secondary to BPH. If
the prostate is embolized due to bleeding, use code 37244 instead of 37243. This
concept also applies to transhepatic portal vein embolization and splenic arterial
embolization done to shrink a lobe of the liver or shrink an enlarged spleen
(splenomegaly).
122. Use code 37242 or 37244 to describe uterine artery embolization for treatment of any
uterine abnormality other than fibroids (e.g., uterine AVM, post-partum hemmorhage,
respectively). In these cases, do separately bill the medically necessary imaging in
addition to the catheter placements.
123. Report code 37241 for transcatheter treatment (via direct puncture or leg vein access)
of true venous malformations (as seen with Klippel-Trenaunay syndrome) with or
without selective catheter manipulation and injection/embolization of the abnormality.
Do not report code 37241 when the procedure is to ablate or treat by sclerotherapy a
varicose vein, perforator vein, or collateral vein of the lower extremity caused by venous
insufficiency. Lower extremity varicose veins are not venous malformations.
124. Do not bill embolization code 37241 for "sclerotherapy" of varicose veins or
perforating veins of the lower extremity when performed by direct puncture. This is
described by codes 36470, 36471, 36465, 36466, 36482, or 36483. Use codes 36470 and

36471 for "needle" injection of a compounded sclerosant; use codes 36465 and 36466
for catheter injection of non-compounded (e.g., Varithena®) foam sclerosant (without
mechanical disruption of the intima). Gel foam "embolization" is considered part of any
varicose vein therapy and is not separately reported as an embolization. If ultrasound
guidance is utilized during this procedure, use code 76942 once per patient encounter.
Documentation must include a permanent recorded image to submit code 76942.
"Endomechanical" ablation of varicose veins uses a device (e.g., ClariVein™) to disrupt
the intima of the vein, which is described by codes 36473 and 36474. When a long
catheter is used to deliver a chemical adhesive (e.g., cyanoacrylate, VenaSeal™)
throughout the entire affected vein, including remote locations from the access site, use
codes 36482 and 36483.
125. Use codes 37242-52 (or -74 for hospital billing) and 75736-50, as well as the
appropriate catheter placement codes, for initial diagnostic pelvic angiography and
placement of bilateral arterial occlusion balloons that may be inflated in a patient to
prevent pelvic hemorrhage. Code 37242-52 (or -74 for hospital billing) should only be
billed once when bilateral balloon inflation to prevent pelvic hemorrhage is performed.
If catheters are placed and not inflated, only bill the catheter placements and diagnostic
imaging. If permanent embolization is necessary, remove the -52/-74 modifier from the
embolization code.
126. Use code 37244-52 (or -74 for hospital billing) if temporary balloon inflation is
performed during the high risk surgical procedure to control or treat an active
hemorrhage.
127. If permanent embolization/occlusion (e.g., with coils) is required, remove the -52/-74
modifier from the appropriate embolization code (see coding instructions #28 and #29).
128. Code 36002 is specific for thrombin injection to treat pseudoaneurysm. Ultrasound
guidance is usually performed and is reported with code 76942. Use code 37242 when
coil embolization is necessary. Use code 34707 or 34708 when a covered ilio-iliac stent
graft is placed across an iliac pseudoaneurysm. Codes 34707 and 34708 are
inpatient-only (status indicator C) for Medicare.
129. The ultrasound guidance code for pseudoaneurysm thrombin injection is 76942, not
76937.
130. Use code 37241 to report alcohol, STS, or other embolization of a superficial venous
malformation of the face by direct access injection. "Non-selective" catheter placement
is bundled during embolization procedures per the NCCI Manual (version 24.0). Report
unlisted fluoroscopy procedure code 76496 for any diagnostic imaging performed prior
to the embolization.
131. Embolization treatment of multiple abnormalities in a single organ (e.g., multiple AVM
in a single kidney, multiple tumors in a single kidney or liver, multiple aneurysms in a
single kidney) is considered embolization of a single surgical site and is coded as a single
embolization. Physicians should consider adding modifier -22 in these cases if the
procedure is substantially more complex and time-intensive than usual cases.

132. Follow-up angiography is bundled with codes 37241-37244. This includes follow-up
using cone beam CT with 3D reconstructions during the embolization.

Neuroembolization Guidelines
1. Use code 37241 to describe embolization by direct needle access into head and neck
venous abnormalities (e.g., facial or tongue venous malformation). The non-selective
catheter placement is bundled.
2. Use code 37243 to describe embolization by direct needle access into head and neck
tumors (e.g., carotid body tumor, glomus tumor).
3. Do not use codes 37241-37244 to describe transcatheter CNS or head and neck
embolizations.
4. Code 61624 describes transcatheter central nervous system embolization (CNS)
procedures. This can be for arterial or venous embolization procedures of the brain or
spinal cord. Use code 61650 for the intra-arterial cerebral chemoinfusion for treatment
of CNS tumors.
5. Code 61626 describes transcatheter head and neck (non-CNS) embolization procedures
(e.g., nose bleed, facial AVM).
6. Code 75894 is reported with embolization procedure codes 61624 and 61626. This is a
paired code.
7. Code 75898 is reported separately for documented angiographic filming as follow-up
after neuro embolizations (61624 and 61626). Society guidelines for intracranial (CNS)
embolization is to use code 75898 as often as medically necessary to complete the
procedure and only once for completion angiography for head and neck embolizations.
Be aware that there is a date of service MUE of two for code 75898, which limits its use
with Medicare patients during CNS embolization procedures.
8. Code 75898 is not used for monitoring progression of the embolization by injecting
contrast along with the embolization material. This imaging is part of guidance and is
included in code 75894 (for neuroembolization procedures described by codes 61624
and 61626). Do not use code 75898 for "pre-deployment" angiography prior to coil
deployment. Code 75898 is for follow-up after coil deployment and for completion
angiography at the conclusion of the embolization.
9. Do not code for "roadmapping" or guiding images during the neuroembolization
procedure. Only code for true diagnostic angiography.
10. Do not code for imaging to "confirm catheter placement" or to localize the catheter tip.
11. Report code 95958 for WADA testing prior to cerebral embolization. Report selective
catheter placements or imaging separately. WADA testing includes injection of propofol
and other medications into the internal carotid artery or selective cerebral arteries.
12. Append modifier -59 for diagnostic imaging procedures at the time of embolization.
13. Code 61623 describes test occlusion of the carotid artery, the vertebral artery, and any
other head or neck vessel that supplies the intracranial or extracranial vasculature.

14. Code 61623 includes all imaging during and after test occlusion procedure except true
diagnostic angiography (see the following coding instruction).

15. Code separately for complete diagnostic angiography (if prior diagnostic study not
previously performed) with carotid test occlusion (61623).

16. Code 61623 includes catheter placement into the vessel evaluated. Do not code
separately for the ipsilateral catheter placement.

17. Code 61623 does not include diagnostic angiography or catheter placement in vessels
other than the test occlusion vessel.

18. Code 61623 includes all neurological evaluation during the test occlusion.
19. Do not use code 61623 for "occlusion balloon angiography" or use of an occlusion

balloon in a non-head or neck, intracranial or extracranial vessel diagnostic study (e.g.,
do not use for renal artery occlusion balloon angiography).

EXAMPLE(S):

1) 38-year-old female with large uterine fibroids and menorrhagia. Via a right transfemoral
approach, a catheter is placed into the right internal iliac artery. The catheter is advanced into
the uterine artery, and embolization is performed. The catheter is then advanced into the left
internal iliac artery, advanced into the uterine artery, and embolization performed (36247-50,
37243).

2) Same patient as example #1, however, the patient has a suspected uterine AVM. Via a right
transfemoral approach, a catheter is placed into the right internal iliac artery followed by
diagnostic pelvic angiography. This demonstrates high flow shunting, requiring glue and larger
sized embolic material. Pelvic angiography is an indicated procedure (75736-59). The catheter is
advanced into the uterine artery and angiography confirms catheter placement (36247).
Embolization is performed with follow-up angiography (37242). The left internal iliac is then
selected and imaged (add -50 modifier to 36247; add -50 modifier to 75736-59). The catheter is
advanced into the uterine artery with additional imaging confirming catheter position, followed
by embolization and follow-up angiography. Abdominal aortography is performed (75625-59).
The ovarian arteries are selected bilaterally (36245-5950) and show no additional supply to the
AVM (75736-5950). (This treatment of a pelvic AVM allows coding for diagnostic imaging,
catheter placements, and the vascular abnormality embolization.)

3) Patient with left iliac wing vascular bone lesion and right thigh bone lesion by CT scan. A
sheath is placed in the left common femoral artery. Diagnostic angiography of the left iliac
system (included in bilateral extremity code) is performed via the sheath. The catheter is placed
in the left internal iliac and advanced to the posterior division. Diagnostic angiography is
performed (75736-59). The catheter is advanced to three smaller branches (36247, 36248,
36248), and embolization is done in each of these vessels (37243). Final post embolization
filming is done from the internal iliac (bundled). The catheter is advanced over the aortic
bifurcation to the right profunda femoris artery (36247-59) with diagnostic angiography
performed (75716-59). The catheter is placed in the right superficial femoral artery and

diagnostic angiography performed (36248, 75774-59). Embolization is performed (37243-59) of
the right thigh lesion via two branches of the profunda femoris artery (36248 - one branch is
included with the initial profunda selection) with post embolization filming (bundled).

4) Patient with clotted AV dialysis fistula. Two punctures: one for diagnostic imaging and the
other for therapeutic intervention (36901); shuntogram including all imaging necessary to
evaluate the arterial inflow, the AV fistula, and venous outflow to the right atrium (included in
36901); and thrombectomy of the fistula (add 36904, delete 36901) show no evidence of
stenosis, but a poorly developed fistula due to two large collaterals. Both collaterals are selected
(bundled) and embolized with coils (36909). Follow-up angiography (bundled) shows improved
flow in the shunt.

5) Patient with proteinuria related to severe renal disease. Patient is not a candidate for surgical
nephrectomy, so permanent vascular occlusion by percutaneous treatment is requested. Via
right common femoral approach, an aortogram (guiding shot - not coded) localizes single
patent renal arteries. Occlusion balloon is placed initially in the proximal right renal artery,
inflated, and 12 cc absolute alcohol infused and allowed to dwell for sixty seconds. The residual
is aspirated and multiple coils deployed proximally (36245, 37243). Follow-up angiography
shows complete occlusion of the right renal artery (bundled). This entire procedure is repeated
on the left (add -50 modifier to codes 36245 and 37243; follow-up angiography is bundled). (The
right and left kidneys represent two surgical sites.)

6) 38-year-old female with severe symptoms of pelvic venous congestion syndrome. From a right
femoral vein approach, a catheter is advanced into the right ovarian (36011-59), left renal, and
the left ovarian veins (36012). Contrast is injected and imaging performed (75833-59). These
images show renal vein reflux into massively dilated venous structures supplying numerous
pelvic varicosities on the left side. Embolization with foam and coils is performed centrally in the
ovarian veins (37241). The catheter is then used to select the right (36011-59) and left internal
iliac veins with venography performed (75822-59). Three enlarged branches off the left internal
iliac (36012-59 x 3) are selected and embolized (37241-59 for separate pelvic embolization).
Follow-up imaging (bundled) shows marked improvement.

7) Patient with endoleak status post EVAR six months ago. Direct access to the aorta via
translumbar approach (bundled). Glue and coils are placed to occlude the native aortic lumen
and endoleak (37242).

Note: Non-selective catheter placement is bundled with embolization per the NCCI Manual
(version 24.0). Do not submit code 36160.

GREY ZONE DISCUSSION:
Code 75898 may be used once per surgical field for head and neck embolization follow-up
imaging (or as often as medically necessary for CNS embolization procedures per SIR).
Follow-up during and after embolizations elsewhere are bundled. Intracranially, code 75898
may be used as often as medically necessary and requires excellent documentation; however,
due to recent date of service MUE implementation, the use of code 75898 is limited to two for
payers that recognize these date of service MUEs. Additional embolization examples are in the

neurointerventional section.

IVC FILTER PLACEMENT

7 Vascular Interventional Coding
Vascular Filter Placement Pages: 251-254

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:

Vascular filter placement procedures involve inserting a catheter into the vessel to be treated,
obtaining images or guiding shots to facilitate accurate choice of filter and determination of
placement site, placing a filter (temporary or permanent filter), repositioning, or removing a
temporary filter.

CLINICAL INDICATIONS:
Prevention of pulmonary embolism in patients with known deep vein thrombosis, patients
with pulmonary embolus, and those with high risk of development of pulmonary embolus.
Filters are usually placed in the infra-renal inferior vena cava, but may be placed in the
suprarenal IVC, the iliac veins, or the superior vena cava. Different filters fit different sized
inferior vena cavas. With very large or occluded cava, bilateral iliac filters may be necessary.
Temporary filters may be removed or repositioned (if inappropriate migration of the filter
occurs) to prolong the temporary protection period. Congenital variation of duplicated IVC
may require placement of two IVC filters to be effective in preventing pulmonary embolism.

CODES: TS T
O& O
PROCEDURE DESCRIPTION AT I AT
PROC P AL C P AL
Insertion of intravascular vena cava filter, endovascular CODE CR O CR
approach including vascular access, vessel selection, and 37191 VD V
radiological supervision and interpretation, intraprocedural 37192 UE U
roadmapping, and imaging guidance (ultrasound and
fluoroscopy), when performed 5 B
Repositioning of intravascular vena cava filter, endovascular 1 6. u
approach including vascular access, vessel selection, and 8 53 n
radiological supervision and interpretation, intraprocedural 4 dl
roadmapping, and imaging guidance (ultrasound and e
fluoroscopy), when performed d

5 10 B
1 .2 u
8 1 n
3 dl
e

d

Retrieval (removal) of intravascular vena cava filter, 37193 5 10 B
endovascular approach including vascular access, vessel 1 .1 u
selection, and radiological supervision and interpretation, 8 9 n
intraprocedural roadmapping, and imaging guidance 3 dl
(ultrasound and fluoroscopy), when performed e
d

Placement iliac vein filter with iliac venogram 37191 5 B
1 6. u
8 53 n
4 dl
e
d

Venography, extremity, unilateral, radiological supervision and 7 5
interpretation 5 1 0.
Venography, caval, inferior, with serialography, radiological 8 8 99
supervision and interpretation 2 1
Venography, caval, superior, with serialography, radiological 0
supervision and interpretation
7 5
5 1 1.
8 8 59
2 3
5

7 5
5 1 1.
8 8 60
2 1
7

CODING INSTRUCTIONS:
133. Codes 37191, 37192, and 37193 bundle catheter placements, diagnostic venography,
guiding shots, and other imaging. Ultrasound guidance for vascular access (76937) is
also bundled with these codes. Do not report transabdominal ultrasound, intravascular
ultrasound (IVUS), or intracardiac echo (ICE), as these are also ultrasound guidance
procedures.
134. Code 37191 describes placement of a new permanent or temporary filter in the vena
cava. A temporary filter is coded the same as a permanent filter. This code bundles
catheter placements, imaging, and filter placement.

135. Temporary filters may be left in the body permanently.
136. Use code 37191 twice if two vena cava filters are placed in congenitally duplicated

IVCs.
137. Use code 37191 for superior vena cava filter placement. This filter may be placed in

patients with upper extremity thrombus and high risk of pulmonary embolism. Codes
37191-37193 describe placement, repositioning, and removal of vena cava filters and
are not specific to superior vs. inferior cava locations. However, most are placed in the
IVC.
138. Do not use code 37191 for use of an embolic protection device.
139. Do not report code 75825 for sizing of the cava, location of the renal veins, or
definition of the venous anatomy when a filter is placed, repositioned, or removed. Do
not use code 75825 to evaluate the IVC for presence of thrombus (in the cava or an
existing filter), duplication of the IVC, or presence of circumaortic left renal vein. The
IVC-gram along with any other necessary imaging (e.g., renal venography, iliac
venography) is bundled in codes 37191-37193.
140. If a patient is seen for IVC filter placement and the initial venography demonstrates
incompatable anatomy for filter placement (e.g., occluded vessel, prior functioning IVC
filter), code for the catheter placement (36010) and vena cavagram (75825) and not an
attempted filter placement.
141. Use code 37191 for iliac vein filters. These may be placed in people with a very large
IVC or in people with an occluded IVC and large pelvic collateral veins. Iliac venography
is bundled here.
142. For bilateral iliac vein filters, use code 37191-50. Do not code for iliac venography or
catheter placement necessary to place the filters.
143. Use code 37192 for repositioning of a temporary filter. This code includes all contrast
injections, imaging, catheter placements, and filter manipulations. If initial venography
demonstrates thrombus in the filter, so the repositioning is abandoned, code for the
catheter placement (36010) and vena cavagram (75825) only, not for an attempted filter
reposition.
144. Do not code for repositioning a newly placed filter (37192) at the same session as
initial placement of the same filter (37191). Properly positioning a filter is inherent to
the initial placement procedures.
145. Use code 37193 for removal of temporary filter. This code includes all contrast
injections, imaging, catheter placements, and filter retrieval. If initial venography
demonstrates thrombus in the filter, so the retrieval is abandoned, code for the
catheter placement (36010) and vena cavogram (75825) only, not for an attempted
filter removal.
146. Do not use code 37197 (retrieval of intravascular foreign body) when an IVC filter is
removed. Use code 37193.
147. If a filter is placed during a thrombolysis/thrombectomy, the clot removal therapy is

successful, and the filter is removed at the end of the same session, submit both the
placement code (37191) and the removal code (37193-59) as appropriate.
148. If a temporary filter is removed, followed by placement of a permanent filter at the
same session, submit both codes 37193-59 (for removal of the old filter) and 37191 (for
placement of the new filter).

EXAMPLE(S):

1) 60-year-old with indeterminate lung scan and dyspnea presents for pulmonary angiography
with filter placement if needed. Via a right transfemoral route, a catheter is selectively placed in
both pulmonary arteries (36014-50) and pressures obtained (bundled, not a right heart cath),
and angiography (75743) shows blood clot in the left lung. The catheter is pulled back into the
inferior vena cava (bundled), and venography is performed (bundled, as filter placement was
anticipated), showing clot in the lower IVC, which mandates higher placement of the filter. A
temporary filter is placed (37191) below the renal veins. Follow-up venography shows good
positioning (no codes).

2) The patient in the above example returns four weeks later for removal of the filter. Using
ultrasound guidance, a sheath is placed via the right jugular vein into the IVC (ultrasound
guidance code 76937 is bundled with codes 37191-37193). The filter is removed (37193)
following an inferior vena cavagram (bundled), showing resolution of IVC clot with a patent
(non-thrombosed) cava and filter.

3) 40-year-old with hip fracture and DVT. Temporary filter was placed three weeks earlier. On
KUB, inferior migration of the filter had occurred. Via right jugular approach, a catheter is
advanced into the IVC. Venography (bundled) shows a patent, but displaced filter. Snare and
sheath are advanced to the IVC; the filter is snared and retracted into the sheath. The filter is
then re-deployed at L2-3 (37192). The sheath is removed.

7 Vascular Interventional Coding Example(s)
Venous Sampling Pages: 255-256 References

Procedure
Clinical Indications
Codes
Coding Instructions

PROCEDURE:
Venous sampling requires placement of a catheter into the venous drainage of the organ to be
sampled. This is usually done bilaterally for comparison. Samples may also be drawn from the
inferior vena cava above and below the organs to be sampled to evaluate for baseline or "step
up" in concentration of the chemical or hormone being evaluated. Catheter placement and

imaging is usually required; unfortunately, these components are bundled into the sampling
codes.

CLINICAL INDICATIONS:
Hypertension (with sampling of the renal veins), hyperaldosteronism (with sampling of the
adrenal veins), hyperparathyroidism (with sampling in the neck), and selective sampling of
the pituitary gland via the petrosal sinus/veins.

CODES: PROC A TOTAL S&I A TOTAL
PROCEDURE DESCRIPTION CODE P RVU CODE P RVU
C C
Venous catheterization for selective organ blood
sampling N 7589 5
36500 / 5.31 3 1
8 0.77
A
4

CODING INSTRUCTIONS:
149. Use a -50 modifier on code 36500 if sampling is done bilaterally (sampling is usually
bilateral but occasionally one side cannot be selected).
150. Do not code for diagnostic venography; it is bundled into code 75893.
151. Do not code for catheter placement required to perform the procedure. It is bundled
into code 36500.
152. Be aware that currently there is no reimbursement to the hospital for codes 36500 and
75893 if both venous sampling and diagnostic venography codes are billed together on a
Medicare patient. Only the incorrect venography code will be reimbursed, and this is at
a lower APC payment rate than the venous sampling code.
153. Do not code for samples obtained non-selectively from the inferior vena cava, superior
vena cava, or a peripheral vein.
154. Code per organ sampled (or in the case of the pituitary, per side sampled). Sampling is
usually performed bilaterally.
155. Do not code for venous sampling during a heart catheterization procedure; it is
bundled into diagnostic heart catheterization codes 93451-93460 and 93530-93533.
156. Bilateral renal vein, adrenal vein, parathyroid vein, and petrosal vein sampling are all
billed and paid the same (36500-50, 75893-50).

EXAMPLE(S):
1) 45-year-old hypertensive patient with right renal artery stenosis of questionable significance
undergoes transfemoral vein puncture with placement of a catheter selectively into the right
renal vein, left renal vein, and high and low inferior vena cava. Imaging is performed. Samples
are obtained from all four sites (36500-50, 75893, 75893-59). (Venography and catheter
placement are included in the sampling.)
Note: IVC sampling is not separately coded.
2) 30-year-old for petrosal vein sampling. Via a transfemoral route, catheter is advanced into
each jugular vein, then anteriorly and cephalad to the level of the cavernous sinus bilaterally.
Imaging is performed at multiple levels. Venous sampling is then performed bilaterally in the
petrosal veins as well as jugular veins and superior vena cava (36500-50, 75893, 75893-59).
(Again, venography and catheter placements are included in the venous sampling codes.)

Saphenous Vein Ablation and Other Treatment of Lower
Extremity Varicose Veins

7 Vascular Interventional Coding

Saphenous Vein Ablation and Other Treatment of Lower Extremity Varicose Veins Pages:
257-263

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
Saphenous vein ablation is a procedure that is performed on patients with symptomatic
varicose veins in the lower extremities after failed conservative therapy with compression
stockings, weight loss (if needed), and leg elevation. An ultrasound is used to initially evaluate
the venous structures and to assist in planning treatment. For mechanochemical,
radiofrequency (RF), laser, or chemical adhesive ablation technique, an incision or puncture is
made into the abnormal truncal vein, and a catheter is placed. Duplex images or contrast
images may be obtained at surgery, followed by mechanochemical, RF, laser, or chemical
adhesive ablation of the abnormal vein using a specialized catheter or injectate.
Mechanochemical ablation utilizes a specialized catheter to "roughen up" the inner surface of
the vein, followed by injection of a medication (e.g., STS) to induce the venous ablation. All
imaging guidance and monitoring are bundled. Additional veins may be ablated in a similar
fashion. Compounded (by the performing physician) and non-compounded (direct from the
manufacturer) foam sclerosants may be used for direct injection, while chemical adhesives
(cyanoacrylate or "glue") may be injected via a long catheter into the abnormal truncal vein.
New codes for 2018 describe these recent therapy improvements, while code description
changes affect several other established codes. Other surgical techniques may be utilized at the
same session and include injection via small needles of hypertonic saline or other sclerosing
agents into spider veins or larger varicose veins followed by compression. These procedures
may be performed over multiple sessions. Stab phlebectomy involves a small incision over the
involved vein and use of a small hooking device to remove/avulse the vein. These small
incisions may be closed with suture, staples, or steristrips.

CLINICAL INDICATIONS:
Symptomatic (usually painful) varicosities of the lower extremities.

CODES: PROC CODE TO S
A TA &I
PROCEDURE DESCRIPTION PL C
C RV O
Injection of non-compounded foam sclerosant with ultrasound D
compression maneuvers to guide dispersion of the injectate, U E
inclusive of all imaging guidance and monitoring; single
incompetent extremity truncal vein (eg, great saphenous vein, 36465 5 N
accessory saphenous vein) 0 3. /A
Injection of non-compounded foam sclerosant with ultrasound 5 46
compression maneuvers to guide dispersion of the injectate, 4
inclusive of all imaging guidance and monitoring; multiple
incompetent truncal veins (eg, great saphenous vein, accessory 36466 5 N
saphenous vein), same leg 36468 0 4. /A
Injection(s) of sclerosant for spider veins (telangiectasia), limb or 36470 5 40
trunk 36471 4
36473
Injection of sclerosant; single incompetent vein (other than 5 N
telangiectasia) 0 0. /A
5 00
Injection of sclerosant; multiple incompetent veins (other than 1
telangiectasia), same leg
Endovenous ablation therapy of incompetent vein, extremity, 5 N
inclusive of all imaging guidance and monitoring, percutaneous, 0 1. /A
mechanochemical; first vein treated 5 11
Endovenous ablation therapy of incompetent vein, extremity, 2
inclusive of all imaging guidance and monitoring, percutaneous,
mechanochemical; subsequent vein(s) treated in a single 5 N
extremity, each through separate access sites (List separately in 0 2. /A
addition to code for primary procedure) 5 21
2

5 N
1 5. /A
8 13
3

N 2. N
/ 57 /A
A

36474

Endovenous ablation therapy of incompetent vein, extremity, 36475 5 N
inclusive of all imaging guidance and monitoring, percutaneous, 1 8. /A
radiofrequency; first vein treated 8 14
3

Endovenous ablation therapy of incompetent vein, extremity, N 3. N
inclusive of all imaging guidance and monitoring, percutaneous, / 95 /A
radiofrequency; subsequent vein(s) treated in a single extremity, A
each through separate access sites (List separately in addition to
code for primary procedure) 36476

Endovenous ablation therapy of incompetent vein, extremity, 36478 5 N
inclusive of all imaging guidance and monitoring, percutaneous, 1 8. /A
laser; first vein treated 8 08
3

Endovenous ablation therapy of incompetent vein, extremity, N 3. N
inclusive of all imaging guidance and monitoring, percutaneous, / 96 /A
laser; subsequent vein(s) treated in a single extremity, each A
through separate access sites (List separately in addition to code
for primary procedure) 36479

Endovenous ablation therapy of incompetent vein, extremity, by 36482 5 N
transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) 1 5. /A
remote from the access site, inclusive of all imaging guidance and 8 13
monitoring, percutaneous; first vein treated 4

Endovenous ablation therapy of incompetent vein, extremity, by N 2. N
transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) / 56 /A
remote from the access site, inclusive of all imaging guidance and A
monitoring, percutaneous; subsequent vein(s) treated in a single
extremity, each through separate access sites (List separately in 36483
addition to code for primary procedure)

Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab 37765 5 13 N
incisions 1 .0 /A
8 0
3

Stab phlebectomy of varicose veins, 1 extremity; more than 20 37766 5 15 N
incisions 1 .9 /A
80

3

Unlisted procedure, vascular surgery (stab phlebectomy of 37799 5 N
varicose veins, one extremity; less than 10 incisions) 1 0. /A
8 00
1

Ligation and division of short saphenous vein at saphenopopliteal 37780 5 N
junction (separate procedure) 1 6. /A
8 79
2

Ligation, division, and/or excision of varicose vein cluster(s), 1 leg 37785 5 N
1 7. /A
8 54
3

Add-on Code

CODING INSTRUCTIONS:
157. Codes 36465-36471, 36473-36479, 36482, and 36483 include preliminary imaging,
ultrasound image guidance, catheter placements, ongoing imaging during the procedure,
and completion/follow-up imaging after therapy. These codes also include all supplies,
equipment, and application of compression dressings when performed in the office
setting.
158. Codes 36465, 36466, 36482, and 36483 are new for 2018, while codes 36468, 36470,
and 36471 have been revised.
159. There are three truncal veins: the great saphenous vein, the small (lesser or short)
saphenous vein, and the accessory saphenous vein(s).
160. Tumescent anesthesia requires injection of a normal saline solution with added
lidocaine along and around the treat vein(s). This is sometimes painful, as up to 500 cc
of this mixture is injected. The fluid injected acts to decrease pain of the actual
procedure and as a heat sink to disperse RF and laser "heat" that could otherwise
damage nerves, skin, and other adjacent structures.
161. NTNT refers to non-thermal, non-tumescent anesthesia and is used with non-RF and
non-laser procedures.
162. Code 36469 has been deleted. Code 36468 is reported for treatment of reticulated
varicose vein, telangiectasias, or spider veins with a sclerosing agent. Report code 36468

only once per extremity. This procedure is usually performed with a direct needle
injection. This procedure is considered cosmetic and is not reimbursed by Medicare or
other payers.
163. Codes 36470 and 36471 describe sclerosant injection(s) into incompetent leg vein(s),
including compounded foam sclerosant. These procedures can be performed with a
needle or short catheter (Angiocath).
164. Ultrasound guidance (76942) can be reported with codes 36468, 36470, and 36471.
165. Use code 36470 if one vein is injected. Use code 36471 if more than one vein is
treated.
166. Codes 36470 and 36471 are for use of a compounded sclerosant. The physician usually
mixes the sclerosant with air using a three-way stopcock to mix and create a foam.
Codes 36470 and 36471 may be reported for truncal or non-truncal veins treated with a
compounded sclerosant.
167. Codes 36465 and 36466 describe injection of non-compounded foam sclerosant into
one or multiple incompetent extremity truncal veins respectively. A non-compounded
sclerosant is purchased as a stable foam sclerosant directly from the manufacturer (e.g.,
Varithena, 1% polidocanol injectable foam). Ultrasound and other imaging guidance are
bundled. The sclerosant is dispersed up the vein using ultrasound compression and
guidance.
168. Codes 36482 and 36483 describe use of a catheter that is advanced along the
incompetent extremity vein (remote from the access site) and is pulled back as a
chemical adhesive is delivered. This chemical adhesive disrupts the intima of the vein as
it comes in contact via catheter injection along the course of the vein. Cyanoacrylate
(VenaSeal), better known as glue, is a chemical adhesive used in this procedure.
Ultrasound guidance (76942) is bundled, and the procedure is performed with local
anesthesia (not tumescent anesthesia).
169. Procedures described by codes 36473, 36474, 36482, and 36483 follow similar
guidelines as RF and laser ablation procedures. RF and laser ablation procedures utilize
"tumescent" anesthesia, while mechanochemical ablation and endovenous ablation
with a chemical adhesive utilize "local" anesthesia.
170. Do code additionally if stab phlebectomy is performed on additional veins at the time
of RF or laser ablation of the extremity varicose veins: 37765 (10-20 incisions), 37766
(more than 20 incisions), or 37799 (less than 10 incisions).
171. Additionally report code 37785 for ligation, division, and/or excision of varicose vein
"clusters".
172. Do code additionally if injection of sclerosing agents via needle into additional
non-truncal veins is performed at the same time as RF or laser ablation of the extremity
varicose veins. Use code 36470 or 36471. Use code 36465 or 36466 if injection of
non-compounded foam sclerosant into one or multiple incompetent lower extremity
truncal veins is performed. If

non-compounded foam sclerosant is injected in non-truncal veins, use code 36470 or
36471.
173. Injection of a chemical adhesive (e.g., VenaSeal) with a catheter (remote from the
access site) for treatment of truncal varicose veins is described by codes 36482 and
36483.
174. Do not bill embolization code 37241 for "sclerotherapy" of varicose veins or
perforating veins of the lower extremity when performed by direct puncture. This is
described by codes 36465, 36466, 36470, and 36471. Use codes 36470 and 36471 for
"needle" injection of a compounded sclerosant; use codes 36465 and 36466 for catheter
injection of a non-compounded foam sclerosant. Gel foam "embolization" of selected
perforating veins is considered part of any varicose vein therapy and is not separately
reported.
175. If ultrasound guidance is utilized during this procedure, use code 76942 once per
patient encounter. Documentation must include a permanent recorded image to submit
code 76942. Code 76942 can only be submitted with codes 36468, 36470, and 36471;
however, it is rarely necessary to use this guidance for procedures described by code
36468.
176. Use add-on mechanochemical ablation code 36474, RF ablation code 36476, laser
ablation code 36479, or chemical adhesive ablation code 36483 for additional veins
ablated through separate access sites of other truncal veins in the same leg. Only use
these codes once, regardless of the number of additional separate access sites and
treatments performed on a single leg.
177. Do not use code 36474, 36476, 36479, or 36483 for ablation of additional branches
performed through the original access site.
178. Stab phlebectomy (37765, 37766, 37799) refers to a surgical procedure that involves a
small stab or incision through the skin overlying a varicose vein. A small hook is placed
through this stab and is used to grab the abnormal vein. The vein is then pulled through
the incision and torn (or avulsed) from the rest of the vein. Multiple stabs are often
made along the path of a vein, and the vein is "loosened" and pulled out as one long
vein via one of the stabs. Coding for stab phlebectomy is dependent on the number of
stab incisions the physician performs. Documentation is critical for correct coding.
Discuss this documentation issue with your physicians.
179. Do not use venous embolization code 37241 for endovenous ablation therapy of
incompetent or varicose extremity veins.
180. Do not report code 37241 for "embolization" of varicose extremity veins with
compounded foam sclerosants. This is reported with code 36470 or 36471. Use code
36465 or 36466 for injection and dispersion of a non-compounded foam sclerosant of a
truncal vein.
181. Do not use code 37241 for additional catheter injection of gelfoam or coils to occlude
communicating or perforating veins during mechanochemical, RF, laser, or chemical
adhesive ablation of saphenous veins. Do not use code 37241 for treatment of lower

extremity varicosities.
182. Treatment of true vascular malformations (not varicose veins/varicosities) by direct

percutaneous puncture with alcohol, foam, or other sclerosant or embolic material
injection is reported with code 37241. This code is appropriate for treatment of venous
malformations in patients with Klippel-Trenaunay syndrome (code 37241 is reported
only once per extremity).
183. Do not confuse injection procedures for spider veins (telangiectasias) (36468) with
varicose vein sclerosing agent injection procedures (36465, 36466, 36470, 36471) or
embolization procedures for capillary hemangiomas or true venous malformations.
184. Use codes 36482 and 36483 to describe catheter-based injection remote from the
access of a chemical adhesive (cyanoacrylate) into extremity incompetent truncal veins.
Imaging guidance is bundled with these codes.
185. Use codes 36473 and 36474 for mechanochemical ablation (e.g., ClariVein™ device) of
truncal lower extremity varicose veins. The acronym MOCA also refers to
mechanochemical ablation.
186. Do not use code 76942 for use of ultrasound guidance with procedure codes
36473-36483. Ultrasound is usually not necessary for treatment of superficial spider
veins (36468) and is bundled with mechanochemical, RF, laser, and chemical adhesive
ablation (36473-36483).
187. When "trapped blood" is aspirated subsequent to sclerotherapy (different encounter),
report code 10160, Puncture aspiration of abscess, hematoma, bulla, or cyst, for
aspirating the trapped blood. Modifier -78 should be appended if performed in the
global surgical period of the sclerotherapy.

EXAMPLE(S):

1) 60-year-old with large bilateral varicose saphenous veins. Local anesthetic is infiltrated over
target veins, and using sterile prep and ultrasound guidance (no code), puncture of a varicose
saphenous vein on the left is accomplished followed by RF catheter placement. RF energy is
applied causing ablation (36475). Follow-up ultrasound shows excellent results (no code). The
procedure is repeated on the right leg (add -50 modifier to 36475). An additional separate
truncal varicose vein on the right leg is punctured using ultrasound guidance. RF ablation
catheter is advanced through the sheath with RF energy applied (36476). This is repeated on the
same leg via a separate access (no additional code, included in original 36476 code). Stab
phlebectomy with greater than twenty incisions is additionally performed on this leg (37766).
The incisions are closed with steristrips.

2) Same patient as example #1. However, local anesthetic is administered in the varicose vein,
followed by use of ClariVein™ device to mechanically disrupt the intima of the saphenous vein
with injection of STS (36473). Compression wraps are placed. Two separate additional venous
accesses to truncal veins of the same extremity are made, followed by similar mechanochemical
treatment of smaller incompetent veins (36474).

3) A young female patient presents with a normal lower extremity venous duplex scan. She has
numerous spider veins in the left lower extremity. She would like these treated for cosmetic
reasons. After the area is cleaned with alcohol, a TB syringe is used to inject a small amount of
sodium tetradecyl into multiple spider veins, followed by compression with an ace wrap (36468).
The plan is to perform additional injections in one week.

4) Patient with continued varicosities into the left calf after laser ablation of the saphenous vein.
Direct puncture of the enlarged tributary is performed with placement of a short 4 French
sheath. A catheter is advanced centrally, and VenaSeal (cyanoacrylate glue) is injected during
catheter pullback (36482). Stab phlebectomy of separate varicosities is performed with eleven
separate incisions documented (37765) with removal of the affected vein. Compression dressing
is applied.

5) Patient with incompetent greater saphenous and accessory saphenous veins. Puncture of the
distal greater saphenous vein with placement of a short Angiocath is performed, followed by
injection of a non-compounded foam sclerosant (Varithena, 1% polidocanol foam sclerosant).
During the local injection, ultrasound is used to disperse the agent throughout the greater
saphenous vein (36465). A separate puncture and Angiocath placement in the accessory
saphenous vein is performed, followed by a similar local injection with ultrasound-guided
dispersion (add 36466, delete 36465). Compression dressings are applied.

Percutaneous Transcatheter Renal Sympathetic
Denervation

7 Vascular Interventional Coding
Percutaneous Transcatheter Renal Sympathetic Denervation Pages: 264-265

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
For patients with severe or malignant refractory hypertension, a procedure has been developed
that utilizes any method of ablation of the sympathetic nerves around the outer wall of the
proximal right and/or left main renal artery. Disruption of these nerves can result in substantial
decrease in blood pressure in patients with difficult to control hypertension. A diagnostic

angiogram is usually performed, followed by placement of a specialized catheter (e.g.,
OneShot™ renal denervation device, Simplicity™ RF ablation catheter) for application of
transluminal thermal (radiofrequency ablation) energy to destroy the nerves around the renal
artery. Other techniques that have been shown to be effective in destroying these nerves
include alcohol injections (via the Perigrine catheter) and ultrasound disruption of the nerves at
this location. Category III codes describe renal denervation by any of these techniques.

CLINICAL INDICATIONS:
Refractory severe or malignant hypertension.

CODES: PROC CODE TO S
A TA &I
PROCEDURE DESCRIPTION PL C
C RV O
Transcatheter renal sympathetic denervation, percutaneous D
approach including arterial puncture, selective catheter U E
placement(s) renal artery(ies), fluoroscopy, contrast injection(s),
intraprocedural roadmapping and radiological supervision and 0338T 5 N
interpretation, including pressure gradient measurements, flush 1 0. /A
aortogram and diagnostic renal angiography when performed; 9 00
unilateral 2
Transcatheter renal sympathetic denervation, percutaneous
approach including arterial puncture, selective catheter 0339T 5 N
placement(s) renal artery(ies), fluoroscopy, contrast injection(s), 1 0. /A
intraprocedural roadmapping and radiological supervision and 9 00
interpretation, including pressure gradient measurements, flush 2
aortogram and diagnostic renal angiography when performed;
bilateral

CODING INSTRUCTIONS:
188. Codes 0338T and 0339T describe transcatheter renal sympathetic denervation.
189. Use code 0338T for unilateral procedures.
190. Use code 0339T for bilateral procedures.
191. Codes 0338T and 0339T bundle the renal artery catheter placements, diagnostic
abdominal aortography, selective renal angiography, all intraprocedural imaging and

follow-up, intrarenal pressure determinations, and renal sympathetic nerve destruction
by any percutaneous transcatheter method (e.g., RF ablation, transluminal denatured
alcohol injection, focused ultrasound ablation).
192. Do not submit code 75625, 36200, 36245, 36251-36254, or 75898 with this procedure.

EXAMPLE(S):

1) 62-year-old female with resistant hypertension despite multiple drug regimen. Via a right
femoral approach, a 6 French sheath is placed. Aortography, followed by selective bilateral
renal angiography (bundled), shows widely patent renal arteries. A Simplicity RF ablation
catheter is advanced through a guiding sheath into each proximal renal artery. Two-minute RF
ablation is performed while deflecting the catheter in each vessel to reach the appropriate
regions of the vessels (0339T). Catheter and sheath are removed.

BALLOON ANGIOPLASTY , NON-LOWER EXTREMITY

7 Vascular Interventional Coding
Balloon Angioplasty, Non-Lower Extremity Pages: 266-274

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
Balloon angioplasty is utilized by vascular specialists to improve blood flow through a blocked
or narrowed vessel. This can be performed in veins and arteries. The first vessel dilation was
performed without balloons and was called the "Dotter" technique, named after Dr. Charles
Dotter. It required passing larger and larger tubes (catheters) across a blockage to open up flow.
About thirty years ago, balloon angioplasty was developed and has been refined by
technological improvements. Angioplasty has become a very common procedure used to open
blocked vessels anywhere in the body, including the viscera, extremities, heart, and brain. Some
of the locations where this procedure is performed along with its indications are still considered
experimental and are non-covered by Medicare (e.g., intracranial vasospasm angioplasty). Refer
to CMS and our website to keep informed of any changes in the use of these codes for
Medicare patients. Coding of angioplasty procedures depends on location and the number of
vessels treated. A code set exists for lower extremity revascularization (37220-37235). This
involves angioplasty of the iliac, femoral/popliteal, and tibial/peroneal vessels. Different
guidelines have been developed for angioplasty in these vessels. These guidelines differ from
the renal, visceral, aortic, or brachiocephalic angioplasty procedures. The CPT code descriptions

for angioplasty include angioplasty utilizing a balloon [e.g., micro balloon, compliant balloon,
non-compliant balloon, cryoplasty (Polar cath) balloon, cutting balloon, drug-eluting balloon
(DEB), micro-infusion balloon (Bullfrog), lithoplasty, etc.]. Angioplasty balloons are occasionally
used to predilate a lesion for stent deployment or to fully deploy a stent (included with stent
placement). There are separate organ specific codes for use of angioplasty balloons in
non-vascular structures (e.g., bile ducts, ureter, GI tract). There are codes for initial and
additional arterial angioplasty (non-coronary, non-CNS, non-pulmonary, and non-lower
extremity) and venoplasty. These codes bundle the S&I, as do all other existing angioplasty
procedure codes.

CLINICAL INDICATIONS:
Vascular ischemia related to atherosclerosis, fibromuscular dysplasia, or intimal hyperplasia
leading to arterial or venous blockages, dissections, arm or leg swelling related to venous
blockages or compressions (e.g., superior vena cava syndrome, May Thurner syndrome), or
poorly functioning AV shunt graft.

CODES:

PROCEDURE DESCRIPTION PROC T S
CODE O &I
A TA C
PL O
CR D
V E
U

Percutaneous or Open Angioplasty, Non-Lower Extremity

Transluminal balloon angioplasty (except lower extremity 37246 5 10 N
artery(ies) for occlusive disease, intracranial, coronary, pulmonary, 1 .1 /A
or dialysis circuit), open or percutaneous, including all imaging and 9 4
radiological supervision and interpretation necessary to perform 2
the angioplasty within the same artery; initial artery

Transluminal balloon angioplasty (except lower extremity N 4. N
artery(ies) for occlusive disease, intracranial, coronary, pulmonary, / 98 /A
or dialysis circuit), open or percutaneous, including all imaging and A
radiological supervision and interpretation necessary to perform
the angioplasty within the same artery; each additional artery (List 37247
separately in addition to code for primary procedure)

Transluminal balloon angioplasty (except dialysis circuit), open or 5 8. N
percutaneous, including all imaging and radiological supervision 37248 1 68 /A
and interpretation necessary to perform the angioplasty within the 9

same vein; initial vein 2

Transluminal balloon angioplasty (except dialysis circuit), open or N 4. N
percutaneous, including all imaging and radiological supervision / 22 /A
and interpretation necessary to perform the angioplasty within the A
same vein; each additional vein (List separately in addition to code
for primary procedure) 37249

Percutaneous transluminal pulmonary artery balloon angioplasty; 92997 5 19 N
single vessel 1 .0 /A
9 5
3

Percutaneous transluminal pulmonary artery balloon angioplasty; N 9. N
each additional vessel (List separately in addition to code for / 45 /A
primary procedure) A

92998

Revascularization, endovascular, open or percutaneous, iliac 37220 5 11 N
artery, unilateral, initial vessel; with transluminal angioplasty 1 .7 /A
9 2
2

Revascularization, endovascular, open or percutaneous, femoral, 37224 5 12 N
popliteal artery(s), unilateral; with transluminal angioplasty 1 .9 /A
9 7
2

AV Shunt Angioplasty

Introduction of needle(s) and/or catheter(s), dialysis circuit, with 36902 5 N
diagnostic angiography of the dialysis circuit, including all direct 1 6. /A
puncture(s) and catheter placement(s), injection(s) of contrast, all 9 98
necessary imaging from the arterial anastomosis and adjacent 2
artery through entire venous outflow including the inferior or
superior vena cava, fluoroscopic guidance, radiological supervision
and interpretation and image documentation and report; with
transluminal balloon angioplasty, peripheral dialysis segment,
including all imaging and radiological supervision and
interpretation necessary to perform the angioplasty

Percutaneous transluminal mechanical thrombectomy and/or 36905 5 12 N
infusion for thrombolysis, dialysis circuit, any method, including all 1 .9 /A

imaging and radiological supervision and interpretation, diagnostic 94
angiography, fluoroscopic guidance, catheter placement(s), and 3
intraprocedural pharmacological thrombolytic injection(s); with
transluminal balloon angioplasty, peripheral dialysis segment,
including all imaging and radiological supervision and
interpretation necessary to perform the angioplasty

Transluminal balloon angioplasty, central dialysis segment, N 4. N
performed through dialysis circuit, including all imaging and / 28 /A
radiological supervision and interpretation required to perform the A
angioplasty (List separately in addition to code for primary
procedure) 36907

Intracranial Angioplasty

Balloon angioplasty, intracranial (eg, atherosclerotic stenosis), #♦ 61630 N 39 N
percutaneous / .8 /A
A1

Transcatheter placement of intravascular stent(s), intracranial (eg, #♦ 61635 N 42 N
atherosclerotic stenosis), including balloon angioplasty, if / .4 /A
performed A2

Balloon dilatation of intracranial vasospasm, percutaneous; initial #61640 N 14 N
vessel / .0 /A
A1

Balloon dilatation of intracranial vasospasm, percutaneous; each # N 4. N
additional vessel in same vascular family (List separately in / 92 /A
addition to code for primary procedure) 61641 A
#
Balloon dilatation of intracranial vasospasm, percutaneous; each N 9. N
additional vessel in different vascular family (List separately in 61642 / 84 /A
addition to code for primary procedure) 0338T A
Transcatheter renal sympathetic denervation, percutaneous
approach including arterial puncture, selective catheter 5 0. N
placement(s) renal artery(ies), fluoroscopy, contrast injection(s), 1 00 /A
9