Summary & Overview
CPT 37289: Atherectomy with Angioplasty in Additional Tibial/Peroneal Vessel
CPT code 37289 denotes atherectomy, with angioplasty when performed, in an additional tibial or peroneal vessel carried out during the same session as an initial tibial or peroneal revascularization. It specifically covers treatment in the anterior tibial, posterior tibial, and peroneal arteries and bundles all procedural components including access, catheterization, lesion crossing, and imaging guidance. The code matters nationally because peripheral endovascular interventions for critical limb ischemia and peripheral arterial disease are common and resource-intensive, with implications for procedure coding consistency, hospital and ambulatory surgery center billing, and payer coverage policies.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of what CPT code 37289 represents, clinical context for when the code applies, and the types of benchmarking and policy considerations typically associated with peripheral endovascular services. The publication also outlines where CPT 37289 fits relative to other peripheral vascular procedure codes, highlights common clinical scenarios that prompt use of the code, and notes typical sites of service. Data not available in the input includes specific modifier guidance, associated taxonomies, a list of related ICD-10 diagnosis codes, and payer-specific coverage edits.
Billing Code Overview
CPT code 37289 describes an endovascular atherectomy with angioplasty of an additional tibial or peroneal vessel performed during the same session as an initial tibial or peroneal revascularization. The procedure involves removal or debulking of plaque inside an artery in the tibial and peroneal vascular territory (anterior tibial, posterior tibial, and peroneal arteries) and includes angioplasty when performed. The service includes all access, catheterization, lesion crossing, and imaging guidance needed to complete the procedure.
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Service type: Endovascular peripheral arterial intervention (atherectomy with possible angioplasty) as an adjunctive procedure performed in the same session as initial tibial or peroneal revascularization
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Typical site of service: Hospital inpatient or outpatient interventional radiology/cardiovascular catheterization laboratory or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of peripheral artery disease, diabetes mellitus, and rest pain of the foot presents for lower-extremity revascularization. After diagnostic angiography confirms an occlusive tibial artery lesion in the anterior tibial artery and a separate, additional straightforward stenotic lesion in the posterior tibial artery, the vascular specialist performs an initial tibial or peroneal revascularization (stent or angioplasty) in one vessel. At the same session, the provider performs 37289 — atherectomy (with angioplasty when performed) of a straightforward lesion in an additional tibial/peroneal vessel. The procedure includes vascular access, catheterization, lesion crossing, intraprocedural imaging guidance (fluoroscopy), plaque debulking with an atherectomy device, and adjunct balloon angioplasty as indicated.
Workflow steps:
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Pre-procedure: vascular assessment, review of noninvasive testing (ABI, duplex), informed consent, regional or general anesthesia selection.
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Intra-procedure: arterial access (common femoral or antegrade tibial access), selective catheterization of tibial/peroneal arteries, diagnostic angiography, lesion crossing with guidewire, atherectomy of the additional tibial/peroneal vessel (
37289) with intravascular imaging/angiography, adjunctive angioplasty when performed, hemostasis and access site management. -
Post-procedure: vascular monitoring, duplex or angiographic runoff confirmation, wound/limb perfusion assessment, discharge planning with antiplatelet therapy and follow-up surveillance.