Summary & Overview
CPT 37293: Tibial/Peroneal Revascularization with Stent and Atherectomy
CPT code 37293 represents an add-on peripheral endovascular revascularization procedure in the tibial and peroneal vascular territory performed during the same session as an initial tibial or peroneal revascularization. The service is defined by combined stent placement and atherectomy, and may include angioplasty, for a straightforward stenotic lesion in an additional tibial or peroneal vessel (anterior tibial, posterior tibial, or peroneal artery). This code bundles all access, catheterization, lesion crossing, and imaging guidance required to complete the intervention and permits either a percutaneous or open approach.
Nationally, 37293 matters because peripheral limb salvage and revascularization procedures are a significant component of vascular surgery and interventional radiology practice, with implications for hospital procedural volume, payer coverage policies, and clinical quality tracking. Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical intent and service context for 37293, a review of typical sites of service and service type, and a roundup of the payer landscape covered. The publication also addresses benchmarking considerations, relevant coding relationships, and policy updates that affect coverage and billing for peripheral tibial/peroneal revascularization procedures. Data not available in the input where specifics are required will be noted.
Billing Code Overview
CPT code 37293 describes an add-on endovascular revascularization procedure in the tibial and peroneal vascular territory performed during the same session as an initial tibial or peroneal revascularization. The service involves revascularization with both stent placement and atherectomy (plaque removal) in an additional vessel and may include angioplasty for a straightforward lesion (stenosis) in the anterior tibial, posterior tibial, or peroneal arteries. The code encompasses all necessary access, catheterization, lesion crossing, and imaging guidance to complete the procedure. The approach may be percutaneous or open.
Service Type: The service is an endovascular/transcatheter peripheral revascularization procedure performed as an additional vessel treatment during the same session as an initial tibial or peroneal revascularization.
Typical Site of Service: Typical sites of service include hospital inpatient, hospital outpatient (including ambulatory surgery centers), and other procedural settings where vascular interventions are performed.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with peripheral arterial disease presents with lifestyle-limiting claudication and a nonhealing ischemic foot ulcer. Noninvasive testing (ABI and duplex ultrasound) and diagnostic angiography demonstrate an initial tibial or peroneal vessel that requires revascularization with stent and atherectomy. During the same session, an additional straightforward stenotic lesion in another tibial/peroneal artery is treated by atherectomy with stent placement and may include angioplasty. The procedural workflow includes vascular access (commonly common femoral or antegrade tibial access), selective catheterization of the tibial/peroneal arteries, crossing the lesion with wire and catheter, intravascular imaging as needed, plaque removal with atherectomy device, stent deployment, and completion angiography. The encounter includes peri-procedural anticoagulation, hemostasis, and postoperative monitoring; the approach may be percutaneous or via open access depending on anatomy and operator judgment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service on the same day | Use when a distinct E/M encounter is performed and documented on the same day as the procedure |
26 |