Basics of CPT code 37217 & 37218
We know that for upper extremity catheterization we have CPT codes ranging for 36221-36228. These codes are bundled codes and includes all the minor procedures with them. As far as catheter placement in Carotid artery and Inominate artery is considered we can easily code from these codes. But, when we talk about coding interventional procedures performed on these codes we have to use separate codes. If you are perfect with diagnostic and interventional procedures for vascular section, you can easily code intereventional radiology reports. These techniques also help in clearing CPC (Certified Professional Coder) exam, which has few questions from this section as well. Now, let us checkout how we code a Stent placement procedure in Carotid and Innominate Artery.
Details about (CPT code 37217 & 37218) Carotid and Innominate Artery stent
Before we go ahead we would first understand the concept of antegrade and retrograde stent placement. Many of us have little confusion when these words appear in the medical report. Retrograde stent placement means insertion of the endovascular stent in the opposite direction of blood flow toward the aortic arch through the common carotid artery in the neck distal to the occlusive lesion. We have a CPT code 37217 which is used to report open surgical exposure of the cervical carotid artery and retrograde stent placement in the intrathoracic common carotid and innominate arteries. So, do remember whenever a stent is placed in retrograde manner which is against the direction of blood flow toward the aortic arch through the common carotid artery, we can go ahead and report CPT code 37217.
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Antegrade, which is nothing but exactly opposite of retrograde. Antegrade stent placement here means insertion of an endovascular stent from the aortic arch into the common carotid artery in the direction of blood flow across the occlusive lesion. So, retrograde goes against the direction of blood flow while antegrade goes in the direction of blood flow. CPT code 37218 is used to report for antegrade stent placement in the innominate or intrathoracic common carotid artery. Always remember the “antegrade” and “retrograde” refer to the segment of vessel being stented and not to the manner in which vascular access is obtained. So, considering this, if a retrograde brachial approach to place a stent in the right or left common carotid artery would be considered as antegrade placement of the stent because the target area is crossed in an antegrade manner.
37217 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation
37218 Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation
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When to use CPT 37217 and 37218
CPT 37217 is limited to procedures performed though open exposure of the carotid artery. For CPT code 37218, the code descriptions strictly specifies the stent placement should be performed in antegrade direction in the treated vessel. For most of these procedure the access is always retrograde in the common femoral artery and the stent is placed in an antegrade direction. Hence, both of these codes are not applicable when a percutaneous stent is placed in the innominate artery in a retrograde manner (eg, ipsilateral brachial artery or carotid puncture). We have to use separate CPT Codes for such procedures. CPT code 37236 is reported for innominate artery stent placement from an ipsilateral retrograde peripheral vascular access. The Code 37236 does not include the catheterization of vessel and hence should be coded separately.
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Do and Don’t with CPT code 37217 and 37218
Do not code Selective Catheterization procedure codes (36221 or 36222) separately; they are inherently included in the CPT codes 37217 and 37218. Always remember Selective catheterization and diagnostic arteriography are always included in these CPT codes.
Do not report Angioplasty procedure codes with these CPT codes, they are included in these CPT codes.
Do not report any diagnostic imaging for ipsilateral extracranial intrathoracic innominate and/or carotid artery stenting. All diagnostic and radiologic supervision and interpretation services are included with CPT codes 37217 and 37218.
An Embolix Protection Device (EPD) is not required with codes 37217, 37218, 0075T, and 0076T for brachiocephalic, common carotid, or vertebral stent placement.
Use CPT code 37217 when common carotid stent placement is via ipsilateral carotid cutdown, and use CPT code 37218 when common carotid stent placement is via an antegrade (e.g., femoral access) approach.