Clinical Context
A 72-year-old man with a history of peripheral arterial disease, hypertension, and smoking presents with worsening right lower-extremity claudication and diminished ankle-brachial index. Noninvasive testing and CT angiography show a significant stenosis in the right common iliac artery and a separate chronic total occlusion of the ipsilateral external iliac artery. The vascular interventional team plans an initial iliac revascularization service with stent placement to treat the primary lesion. During the same operative session, after establishing vascular access and performing angiography, the interventionalist performs balloon angioplasty of the additional complex occluded iliac vessel to restore inline flow.
The clinical workflow includes pre-procedure evaluation and informed consent, vascular access (percutaneous or open), diagnostic angiography, lesion crossing techniques for the occluded segment, balloon angioplasty of the additional complex lesion, adjunctive imaging (fluoroscopy and digital subtraction angiography), hemostasis, and post-procedure monitoring in a recovery area or vascular observation unit. Typical personnel include an interventional vascular surgeon or interventional radiologist, technologists, nursing staff, and anesthesia as required. Typical sites of service are hospital inpatient, hospital outpatient (ambulatory surgery center within hospital), or freestanding ambulatory surgical center, depending on patient comorbidities and institutional capabilities.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
37254 | Transcatheter placement of intravascular stent(s), iliac artery, unilateral, with angioplasty when performed; initial vessel | Often reported for the primary iliac stent placement during the same session; 37257 is reported for angioplasty of an additional complex occluded iliac vessel at the same session. |
| 37258 | Transcatheter placement of intravascular stent(s), iliac artery, bilateral, with angioplasty when performed; initial vessel(s) | Used when bilateral iliac stenting is performed; may be part of the overall iliac revascularization strategy.
| 36011 | Introduction of needle or intracatheter, arterial, for diagnostic purposes, without radiological supervision and interpretation, not elsewhere classified | Represents arterial access techniques; diagnostic arterial access and catheter placement are components of iliac interventions and may be reported when separately payable per payer rules.
| 93580 | Catheter introduction for diagnostic angiography, peripheral arterial, with imaging supervision and interpretation; iliac/celiac/mesenteric or extremity vessels | Represents diagnostic peripheral angiography of the iliac vessels that commonly precedes therapeutic iliac angioplasty/stenting.
| 37246 | Revascularization, endovascular, open or percutaneous, including angioplasty, atherectomy, and/or stent, any vascular family, initial vessel | May be used in some coding scenarios for peripheral endovascular revascularization when code sets are grouped; selection depends on exact vessel and payer guidance.
| 76937 | Ultrasound guidance for vascular access | Used when ultrasound guidance is employed for vascular access during percutaneous iliac interventions.
| 36415 | Collection of venous blood by venipuncture | Represents common ancillary services for pre- and intra-procedural labs; billed separately when applicable.
| 99024 | Postoperative follow-up visit, during a global period, related to the original procedure | Used for routine post-op visits during the global period; documentation must support routine nature.
| 92973 | Transcatheter therapy, not otherwise specified (for noncoronary vascular beds) | Rarely used; include only per coding guidance when no specific code applies.
| 77012 | Computed tomography guidance for diagnostic, surveillance, or therapeutic procedures (list separately in addition to primary procedure) | Used when CT guidance is used for lesion localization or crossing adjunctively during complex iliac interventions.