Clinical Context
A 72-year-old male with a history of peripheral artery disease, smoking, hypertension, and intermittent claudication presents with progressive rest pain and worsening ambulation. Noninvasive testing and angiography demonstrate a chronically occluded superficial femoral artery in one limb and a separate complex occlusive lesion in the popliteal artery of the same limb. The vascular interventionalist performs an initial femoral/popliteal revascularization in the primary target vessel and, in the same session, treats an additional complex lesion in the femoral/popliteal territory using atherectomy and stent placement with adjunctive balloon angioplasty as needed.
The clinical workflow includes pre-procedure assessment (vascular exam, ABIs, duplex/CTA/angiography), informed consent, sterile arterial access (common femoral or alternate), diagnostic angiography, lesion crossing with wires/catheters, atherectomy to debulk plaque, stent deployment to scaffold the artery, angioplasty for optimization, intraprocedural imaging guidance (fluoroscopy/angiography), hemostasis and access closure, and post-procedure monitoring in a recovery area with vascular checks and antiplatelet management. The service includes all access, catheterization, lesion crossing, and imaging guidance and may be performed percutaneously or via open approach.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
37226 | Revascularization, endovascular, open or percutaneous, of the superficial femoral artery, including angioplasty and stent when performed; initial vessel | Performed when an initial femoral/popliteal revascularization is billed separately; 37278 describes treatment of an additional complex vessel at the same session. |
| 37227 | Revascularization, endovascular, open or percutaneous, of the superficial femoral artery; each additional vessel treated in the same setting (list separately in addition to code for primary procedure) | Billed for additional vessel revascularizations that are not specific to complex lesion with atherectomy + stent; may be used for additional non-complex vessels.
| 37224 | Transcatheter placement of intravascular stent(s), peripheral, any method, inclusive of angioplasty within the same vessel, initial vessel | Used when stent placement is a primary service for peripheral arteries; relates to stenting portions of femoropopliteal interventions.
| 35476 | Atherectomy, peripheral, open or percutaneous, other than coronary, any method (note: commonly coded as 37184/37233 depending on vessel) | Atherectomy technique codes may be used depending on payer rules; documents debulking procedure that complements stent placement in femoropopliteal lesions.
| 36010 | Introduction of catheter, vena cava; diagnostic or therapeutic, not otherwise specified | Represents access and catheterization procedures that may be part of vascular interventions when separately reportable.
| 76000 | Fluoroscopy; supervision and interpretation | Imaging guidance codes are tied to the procedural imaging performed during endovascular therapy and are included or billed per payer policy if separate reporting is allowed.