Cardiology Coding Alert

Question: The patient was prepped, and anesthesia was administered. My physician employed a percutaneous transcatheter stent placement technique, so they used a small incision to access the vessel through the skin. They advanced a catheter through the vessels toward the area requiring treatment. Next, my physician administered contrast material into the vessel to investigate the exact location and extent of the vascular abnormality. They also performed an angioplasty to prepare the site. With the assistance of a guidewire, my physician inserted the catheter stent system into the lumen of the superior vena cava. The stent was delivered at the site of the vascular occlusion to increase the diameter of the stenosed vessel. My physician used radiological guidance to monitor the stent placement inside the vessel lumen. They withdrew the catheter after the appropriate level of recanalization of the occluded vessel was achieved through the stent delivery. Finally, they closed the access site using an arterial closure device. How should I report this procedure?

AAPC Forum Member

Answer: This is an example of a superior vena cava stent placement, so you should report 37238 (Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein).

Don’t miss: Codes 37238 and +37239 (Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure)) describe transluminal intravascular stent insertion in a vein, while 37236 (Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery)) and +37237 (Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure)) describe transluminal intravascular stent insertion in an artery, per the CPT^® guidelines. “Multiple stents placed in a single vessel may only be reported with a single code. If a lesion extends across the margins of one vessel into another but can be treated with a single therapy, the intervention should be reported only once.”

Also, 37236-37239 include radiological supervision and interpretation directly related to the intervention(s) performed, closure of the arteriotomy by pressure, application of an arterial closure device or standard closure of the puncture by suture, and imaging performed to document completion of the intervention in addition to the intervention(s) performed.