Atherectomy is a common peripheral vascular procedure, and coding it correctly can be confusing because the rules change depending on which artery is treated. This guide breaks down everything medical coders, billers, and healthcare professionals need to know about atherectomy coding — in plain, step-by-step language.
What Is Atherectomy?
Atherectomy is a procedure used to remove atherosclerotic plaque (fatty buildup) from inside an artery. A physician inserts a special catheter fitted with a rotary cutter and guides it through the artery using real-time imaging (radiographic guidance).
How is this different from angioplasty or stenting?
- Angioplasty and stent placement work by pushing plaque against the artery wall to widen the vessel.
- Atherectomy actually removes the plaque — by cutting, shaving, or vaporizing it away from the arterial wall.
Because the underlying goal (removing plaque vs. compressing it) is different, atherectomy has its own dedicated set of CPT codes.
The Four Types of Atherectomy Devices
There are four main atherectomy device technologies used in practice:
- Orbital atherectomy
- Rotational atherectomy
- Laser atherectomy
- Directional atherectomy
Important coding note: The CPT code does not change based on which device is used. Coders should base code selection on the type of procedure performed (atherectomy) — not on the brand name of the device.
Documentation tip for physicians: Chart notes should say the procedure was an “atherectomy,” not just the device name. Terms like TurboHawk™ or SilverHawk™ describe the equipment, not the procedure, and using only a brand name can make claims harder to code accurately.
Which Codes Apply to Supra-Inguinal Atherectomy?
CPT Category III codes 0234T–0238T apply to atherectomy performed above the inguinal ligament (supra-inguinal) — meaning arteries other than the legs. These codes apply regardless of whether the procedure is done as an open surgery or a percutaneous (through-the-skin) approach.
These five codes each bundle together:
- The atherectomy procedure itself
- The radiological supervision and interpretation (imaging) needed to perform it
Separately reportable, when applicable:
- Catheterization
- Embolic protection device use
- Other interventions performed
- Closure device use
Note on code structure: Codes 0234T–0238T follow a different structure than the codes used for atherectomy below the inguinal ligament (in the legs), which are 37271–37278 and 37288–37295. Don’t mix the two code sets.
Exception to remember: If another procedure performed in the same session already includes catheterization or closure (for example, a diagnostic angiogram), that procedure’s code may already cover those elements. In that case, catheterization should not be billed separately alongside the supra-inguinal atherectomy code — even though the general rule allows separate coding.
Example: A diagnostic angiogram is performed in the renal artery, followed by atherectomy in the same session. Because catheterization is already included in the renal angiography code, it would not be coded again separately for the atherectomy.
Embolic Protection Devices: What Coders Need to Know
An embolic protection device is often used alongside atherectomy. It’s a small filter or basket attached to a guidewire, placed just beyond the treatment site to catch any debris (thrombus) that breaks loose during the procedure.
Key coding facts:
- There is no specific CPT code for embolic protection.
- Hospitals may report HCPCS code C1884 when an embolic protection device is used.
- Physicians should not report C1884 — this code is for facility/hospital billing only, not physician billing.
One Rule That Applies to Every Artery
No matter how many times the catheter passes back and forth to clear plaque, the atherectomy code is only assigned once per artery treated. Multiple passes in the same vessel do not equal multiple billable procedures.
Atherectomy CPT Codes by Artery: Quick Reference
0234T — Renal Artery Atherectomy
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; renal artery
- Use 0234T for atherectomy of the renal artery.
- Do not add a separate S&I (supervision and interpretation) code.
- If a selective diagnostic renal angiogram is not performed in the same session, report a vascular catheterization code (36245–36248).
- If a selective diagnostic angiogram is performed in the same session, report 36251–36254 instead of a separate catheterization code.
0235T — Visceral Artery Atherectomy (Except Renal)
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; visceral artery (except renal), each vessel
- Use 0235T for atherectomy of a visceral artery other than the renal artery.
- Report a vascular catheterization code.
- Report a diagnostic angiogram S&I code as well, if one was performed.
0236T — Abdominal Aorta Atherectomy
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; abdominal aorta
- Use 0236T for atherectomy of the abdominal aorta.
- Add non-selective catheterization code 36200, unless a selective catheterization was also performed for angiography or for a procedure outside the aorta — in that case, code the selective catheterization instead.
0237T — Brachiocephalic Trunk and Branches Atherectomy
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; brachiocephalic trunk and branches, each vessel
- Use 0237T for atherectomy performed in the neck or upper-extremity arteries.
- Add vascular catheterization code(s) 36215–36218.
0238T — Iliac Artery Atherectomy
Transluminal peripheral atherectomy, open or percutaneous, including radiological supervision and interpretation; iliac artery, each vessel
- Use 0238T for atherectomy of an iliac artery.
- This code is billed “each vessel.” If atherectomy is performed and documented in more than one iliac artery, report the code separately for each vessel treated.
- Catheterization codes may be reported if angioplasty, stent placement, and/or atherectomy is not also performed in the arteries of the same leg. (See the guide’s Lower Extremity Revascularization section for more detail.)
C1884 — Embolization Protective System (Hospital Use Only)
Hospitals billing under the Outpatient Prospective Payment System (OPPS) may assign C1884 when an embolic protection device is used during atherectomy. As noted above, this code is not used by physicians.
Coding Additional Procedures in the Same Artery
Angioplasty, stent placement, or other interventional procedures performed in the same artery during the same session may be coded separately in addition to the atherectomy code, when documentation supports it.
Special note for leg (lower extremity) procedures: Guidelines for coding angioplasty, stent placement, and atherectomy performed in the legs — other than iliac artery atherectomy, which is covered above — are different and are addressed separately in the Lower Extremity Revascularization coding guidelines.
Quick-Reference Summary Table
| Artery Treated | CPT Code | Add Catheterization? |
|---|---|---|
| Renal artery | 0234T | Only if no selective diagnostic angiogram performed (36245–36248); otherwise use 36251–36254 |
| Visceral artery (non-renal) | 0235T | Yes, plus S&I code if angiogram performed |
| Abdominal aorta | 0236T | Yes — 36200, unless selective catheterization performed elsewhere |
| Brachiocephalic trunk/branches | 0237T | Yes — 36215–36218 |
| Iliac artery (each vessel) | 0238T | Only if angioplasty/stent/atherectomy not also done in same-leg arteries |
Frequently Asked Questions
Does the atherectomy CPT code change based on the device (laser, orbital, rotational, directional)? No. All four device types are coded the same way. The code depends on the artery treated, not the equipment used.
Can I bill for each pass of the atherectomy catheter? No. The code is reported once per artery, regardless of how many passes were needed to clear the plaque.
Is there a CPT code for embolic protection devices? No dedicated CPT code exists. Hospitals may use HCPCS code C1884; physicians should not report this code.
What’s the difference between codes for supra-inguinal and lower-extremity atherectomy? Supra-inguinal atherectomy (above the inguinal ligament) uses Category III codes 0234T–0238T. Atherectomy performed below the inguinal ligament, in the legs, uses a different code set: 37271–37278 and 37288–37295.
This guide summarizes CPT/HCPCS coding guidance for transluminal peripheral atherectomy procedures. Always verify current code descriptors and payer-specific policies before billing, as CPT and HCPCS guidelines are updated periodically.
