# 37224 - extremity imaging



## amym (Jul 12, 2011)

Is CPT 37224 the only code I can bill here?

PROCEDURES PERFORMED: 
1. Selective lower extremity imaging. 
2. Percutaneous transluminal angioplasty of the left superficial femoral 
artery/popliteal arteries. 

CLINICAL SUMMARY:  The patient has presented with severe claudication in 
both legs.  He underwent right superficial femoral artery percutaneous 
transluminal angioplasty with marked improvement in his claudication 
symptoms and healing of the ulcer on the right leg.  He now comes in for 
percutaneous transluminal angioplasty of the left superficial femoral 
artery, which is 95% occluded. 

PROTOCOL:  Due to sharp angulation of the bifurcation of the aorta, 
antegrade stick was preferred, which was performed however due to scar 
tissue there was some difficulty in advancing the sheath and therefore 
an Amplatz stiff straight wire was then advanced over a dilator and 
subsequently a 7-French sheath was placed with the intention of possibly 
using stenting.  The lesion was identified as a 95% focal stenosis in 
the superficial femoral artery/popliteal junction and there was a 
secondary lesion, which was in the popliteal artery right at the knee 
joint, which was at least 70% in severity.  Once the balloon inflation 
was performed using 5 x 40 balloon, marked improvement was noted 
in this lesion with less than 30% residual narrowing with margins and no 
evidence of dissection and good flow was noted. 

The second lesion in the popliteal artery was also dilated using the 
same 5 x 40 balloon with some improvement with no dissection.  At this 
point, distal flow was also imaged with the pictures of the trifurcation 
taken in magnification, which reveals that the posterior tibial artery 
has a 90% stenosis and two-vessel runoff is present in the foot. 

FINDINGS:  Successful percutaneous transluminal angioplasty of the left 
superficial femoral artery/popliteal arteries with 5 x 40  balloon with 
stenosis reduction from 95% to less than 30%.


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## dpeoples (Jul 12, 2011)

amym said:


> Is CPT 37224 the only code I can bill here?
> 
> PROCEDURES PERFORMED:
> 1. Selective lower extremity imaging.
> ...



Yes. from CPT " A single interventional code is used no matter what combination of angioplasty/stent/arthrectomy is applied to all segments, including the common, deep, and superficial femoral arteries as well as the popliteal artery"....

HTH


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