Summary & Overview
CPT 37278: Atherectomy and Stent Placement for Additional Femoral/Popliteal Lesion
Headline: CPT code 37278 covers same-session atherectomy with stent placement for a complex additional femoral/popliteal lesion
Lead: CPT code 37278 denotes an endovascular procedure performed during the same operative session as an initial femoral/popliteal revascularization, where the provider performs atherectomy and stent deployment — often with adjunctive angioplasty — to treat a complex lesion (such as an occlusion) in an additional vessel within the femoral and popliteal territory.
Why it matters: This code captures a high-complexity, resource-intensive vascular intervention that affects hospital and outpatient procedural billing, device utilization, and episode-level payments. Nationally, procedures for peripheral arterial disease are high-volume and clinically significant for limb salvage and functional outcomes.
Key payers: Analysis addresses major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides benchmarks for utilization and reimbursement patterns for CPT code 37278, clarifies clinical and billing scope when performed concurrently with an initial femoral/popliteal revascularization, and summarizes relevant policy considerations and coding relationships. It also outlines typical sites of service and the clinical context in which the code is used.
Scope: Content is national in scope and focuses on coding definition, clinical context, payer coverage considerations, and related billing implications for vascular surgery and interventional specialties.
Billing Code Overview
CPT code 37278 describes a secondary endovascular intervention performed during the same session as an initial femoral/popliteal revascularization. The service consists of atherectomy (plaque removal) and stent placement (deployment of a vascular scaffold), and may include angioplasty (balloon expansion), targeted to a complex lesion such as a complete occlusion in an additional vessel within the femoral and popliteal vascular territory. This territory includes the common femoral/profunda femoris and the superficial femoral/popliteal arteries.
Service type: Combined endovascular atherectomy with stent placement (may include angioplasty) for an additional complex femoral/popliteal lesion performed in the same session as an initial revascularization.
Typical site of service: Hospital-based or outpatient vascular/interventional radiology suites or ambulatory surgery centers, using either a percutaneous or open approach; the service includes access, catheterization, lesion crossing, and imaging guidance.
Data not available in the input.
Clinical & Coding Specifications
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure | Use when a distinct E/M visit addressing an acute problem is documented on the same day as 37278. |
| 59 | Distinct procedural service | Use when procedural services are performed on distinct vessels or anatomic sites and documentation supports separation from other procedures in the same session.
| 78 | Unplanned return to the operating/procedure room by the same physician following the initial procedure for a related procedure during the postoperative period | Use for unplanned reintervention in the same operative episode after 37278.
| 79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period of 37278.
| RT | Right side | Use to indicate the procedure was performed on the right lower extremity.
| LT | Left side | Use to indicate the procedure was performed on the left lower extremity.
| 50 | Bilateral procedure | Use when the procedure is performed on both legs and payer requires bilateral modifier instead of RT/LT.
| GA | Waiver of liability statement on file (ABN) | Use when an Advance Beneficiary Notice has been obtained and documented for Medicare when services may be noncovered.
| GC | Service performed in part by a resident under a teaching physician | Use when portions of 37278 are performed by a resident with appropriate teaching physician documentation.
| QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use if anesthesia services requiring this modifier are billed in association with the case (rare for endovascular limb cases under monitored anesthesia care).
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RG0300X | Vascular Surgery | Primary specialty performing open or endovascular femoropopliteal revascularization and stent/atherectomy procedures. |
| 207T00000X | Interventional Cardiology | Frequently performs peripheral vascular interventions in catheterization labs.
| 208800000X | Interventional Radiology | Commonly provides image-guided endovascular therapies including atherectomy and stenting.
| 207L00000X | General Surgery | May perform open or hybrid femoral/popliteal reconstructions and endovascular interventions.
| 364S00000X | Vascular Medicine | Oversees peripheral vascular disease management and coordinates endovascular care.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I70.201 | Unspecified atherosclerosis of native arteries of the extremities, right leg with rest pain | Peripheral arterial atherosclerotic disease causing ischemic symptoms that may necessitate femoropopliteal revascularization with atherectomy and stenting. |
| I70.202 | Unspecified atherosclerosis of native arteries of the extremities, left leg with rest pain | As above, for the left lower extremity requiring intervention.
| I70.211 | Atherosclerosis of native arteries of extremities with intermittent claudication, right leg | Chronic leg ischemia manifesting as exercise-limiting claudication often treated with endovascular revascularization.
| I70.212 | Atherosclerosis of native arteries of extremities with intermittent claudication, left leg | Same clinical context for the left leg.
| I70.239 | Atherosclerosis of native arteries of the extremities with ulceration, unspecified extremity | Ischemic ulceration from peripheral arterial disease that may require revascularization to promote healing.
| I70.241 | Atherosclerosis of native arteries of the extremities with gangrene, right leg | Severe limb-threatening ischemia where revascularization with atherectomy and stenting may be indicated to salvage the limb.
| I70.242 | Atherosclerosis of native arteries of the extremities with gangrene, left leg | Same as above for the left lower extremity.
| I73.9 | Peripheral vascular disease, unspecified | General peripheral vascular disease diagnosis often used when documenting the indication for femoropopliteal intervention.
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.