Clinical Context
A typical patient is a 68-year-old male with progressive left-sided claudication and diminished distal pulses. Noninvasive testing (ankle-brachial index and duplex ultrasound) demonstrates hemodynamically significant stenosis of the left common iliac artery. The vascular surgery team schedules endarterectomy or percutaneous transluminal intervention to restore blood flow. Pre-procedure workflow includes focused history and physical, review of prior imaging (CTA or MRA of the pelvis), assessment of anticoagulation and contrast allergy, and informed consent documenting risks (bleeding, infection, embolization, vessel injury). In the operating room or angiography suite, the provider performs percutaneous or open access, confirms the lesion with angiography, and proceeds with plaque removal (open endarterectomy or directional/aspiration thrombectomy and adjunctive balloon angioplasty/stent placement as indicated). Post-procedure workflow includes hemostasis management, limb perfusion assessment, monitoring for access site complications, antiplatelet/anticoagulation management, and discharge planning with follow-up vascular laboratory testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | No modifier — default billing | Used when no additional modifier applies and standard reimbursement is appropriate. |
| 22 | Increased procedural services | When work or complexity substantially exceeds typical expectations (document justification and time/effort).
| 52 | Reduced services | When the procedure is partially reduced or not completed as planned but still performed (e.g., aborted due to anatomic issues).
| 53 | Discontinued procedure | When terminated prior to completion for patient safety (e.g., intraoperative complication mandates stopping).
| 62 | Two surgeons | When two surgeons of different specialties work together as primary surgeons for a distinct portion of the procedure.
| 66 | Surgical team | When a surgical team billing arrangement is used for complex cases requiring multiple assisting surgeons.
| 78 | Return to OR for related procedure during global period | For unplanned return to the OR for a related intervention within the postoperative global period (e.g., re-exploration for bleeding).
| 79 | Unrelated procedure or service during global period | Not in the provided modifier list; excluded per input restrictions.
| LT | Left side | When the procedure is performed on the left iliac artery.
| RT | Right side | When the procedure is performed on the right iliac artery.
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | When an advanced practice clinician assists and local payer allows assistant billing.
| QX | CRNA service with direction by physician under anesthesia rules | When a certified registered nurse anesthetist provides anesthesia without medical direction by physician (where applicable).
| TC | Technical component | When only the technical component of the service is billed by the facility (e.g., facility bills imaging/technical portion).
| QK | Medical direction of 2–4 concurrent anesthesia procedures | When the physician directs multiple concurrent anesthesia services for the case.
| Taxonomy Code | Specialty | Notes |
|---|
| 207P00000X | Vascular Surgery | Primary specialty performing open iliac endarterectomy and complex peripheral interventions. |
| 2080P0206X | Interventional Cardiology | Performs percutaneous peripheral vascular interventions in some systems.
| 2086S0122X | Interventional Radiology | Commonly performs image-guided endovascular plaque removal and angioplasty/stenting.
| 208D00000X | General Surgery | May perform open vascular procedures in some hospitals.
| 363LP0800X | Nurse Anesthetist | Provides anesthesia services for the procedure.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
I70.2 | Atherosclerosis of native arteries of the extremities | Common underlying etiology for iliac artery plaque causing claudication or ischemia. |
| I74.3 | Embolism and thrombosis of arteries of lower extremity | Acute arterial occlusion that may require thrombectomy or plaque removal.
| I73.9 | Peripheral vascular disease, unspecified | General diagnosis to indicate symptomatic lower extremity ischemia related to iliac lesions.
| I65.29 | Occlusion and stenosis of other extracranial arteries | Included when evaluating comparative arterial occlusive disease; less specific but occasionally used in complex vascular records.
| R63.3 | Cachexia | Not a primary vascular diagnosis; excluded — only clinically relevant codes are listed.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
0238T | Restoration of blood supply in narrowed or blocked portion or branch of the iliac artery; removal of deposited plaque through open or percutaneous approach | Primary procedure restoring iliac artery blood flow via plaque removal. |
| 37220 | Revascularization, endovascular, open or percutaneous, iliac artery, initial vessel; with transluminal angioplasty | Often performed in conjunction when angioplasty is required after plaque removal or when percutaneous approaches are used.
| 37221 | Revascularization, endovascular, open or percutaneous, iliac artery, initial vessel; with stent placement | Used when stent deployment is indicated after plaque removal to maintain vessel patency.
| 35476 | Thrombectomy of iliac artery by catheter; with distal embolic protection | May be used when catheter-based thrombectomy is performed for occlusive thrombus in the iliac segment.
| 35831 | Endarterectomy, other than carotid, including patch graft, if performed; iliac/femoral region | Used for open surgical endarterectomy with patching in the iliac/femoral territory when coded separately per payer rules.
| 76000 | Fluoroscopic guidance for vascular procedures | Imaging guidance commonly reported by facility or physician when separate reporting is allowed.