Peripheral Angioplasty and Stenting (Iliac / Femoral)

CPT 37236
Approach Endovascular
Add-on / Variant CPTs
  • 37237 — Open/percutaneous stent placement, each additional vessel (add-on)
  • 37238 — Open/percutaneous stent placement, same vessel, additional stenosis
  • 75716 — Angiography, extremity, bilateral, radiologic S&I
Preoperative Diagnosis:

Right [left] lower extremity [critical limb ischemia / claudication / rest pain / tissue loss] — [iliac / superficial femoral / popliteal] artery [stenosis / occlusion] on imaging

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] [iliac / superficial femoral / popliteal] artery percutaneous transluminal angioplasty [and stenting]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

Monitored anesthesia care with local — [X] mL 1% lidocaine at access site

Indications:

The patient is a [age]-year-old [male/female] with [critical limb ischemia / disabling claudication / ABI X] secondary to [iliac / SFA] [stenosis / occlusion] confirmed on [CTA / MRA / duplex]. The risks, benefits, and alternatives including open bypass and conservative management were discussed and informed consent was obtained.

Findings:

[Ipsilateral / contralateral] femoral access was obtained. Diagnostic angiography confirmed [focal / diffuse] [stenosis / occlusion] of the [iliac / SFA / popliteal] artery [X] cm in length. The lesion was crossed [with difficulty / without difficulty]. Post-intervention angiography demonstrated [<20% / <30%] residual stenosis with [no flow-limiting dissection / no distal embolization]. Runoff vessels showed [single-vessel / two-vessel / three-vessel] runoff to the foot.

Description of Procedure:

The patient was positioned supine on the angiography table. The [right / left] common femoral artery was accessed [ipsilaterally / via contralateral crossover technique] using an [18-gauge] micropuncture needle under ultrasound guidance. A [6 Fr] sheath was placed.

Heparin [5,000 units / 100 units/kg] was administered intravenously. Diagnostic angiography of the [iliac / femoral / popliteal] system was performed in [AP / oblique] projections. The target lesion was identified: [description of lesion — stenosis, length, location].

A [0.035-inch / 0.018-inch] guidewire was advanced across the lesion. [For occlusion: the lesion was crossed with a [recanalization catheter / support catheter] using [intraluminal / subintimal] technique.] A [X]-mm × [X]-mm angioplasty balloon was advanced and inflated to [X] atm for [X] seconds. Post-angioplasty angiography demonstrated [residual stenosis / flow-limiting dissection], prompting stent placement.

A [X]-mm × [X]-mm [self-expanding nitinol / balloon-expandable] stent was deployed across the lesion under fluoroscopic guidance. Post-stent angioplasty was performed to [X] atm. Completion angiography confirmed [<20%] residual stenosis with no dissection and preserved runoff.

The sheath was removed and hemostasis achieved with [manual compression / closure device — Angioseal / Perclose ProGlide]. Distal pulses were confirmed.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient tolerated the procedure well. Distal pulses were confirmed post-procedure. The patient was monitored for [2–4 hours] and discharged with [dual antiplatelet therapy — aspirin 81 mg + clopidogrel 75 mg / aspirin alone] and follow-up ABI at [4–6 weeks].

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: *** lower extremity ischemia — *** stenosis/occlusion
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: *** artery PTA [and stenting]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: MAC with local

INDICATIONS: .PTAGE-year-old .PTSEX with *** ischemia/ABI ***. *** lesion on imaging. Consent obtained.

FINDINGS: *** access. Angiogram: *** stenosis/occlusion, *** cm. Crossed ***. Post-intervention: <20% residual, no dissection. Runoff: *** vessel.

PROCEDURE:
Supine on angio table. *** femoral access under ultrasound. *** Fr sheath. Heparin ***. Diagnostic angio: *** lesion. Wire across lesion. *** × *** mm balloon, *** atm × *** sec. [Stent: *** × *** mm self-expanding/balloon-expandable deployed.] Post-stent PTA. Completion angio: <20% residual, preserved runoff. Sheath removed, hemostasis with ***. Distal pulses confirmed.

EBL: Minimal
COMPLICATIONS: None
DISPOSITION: Monitored *** hours. DAPT/aspirin. ABI follow-up 4–6 weeks.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Subintimal Angioplasty (Chronic Total Occlusion)

The SFA occlusion was crossed via subintimal technique. A loop was created in the subintimal space with a hydrophilic wire and support catheter. Re-entry into the true lumen was achieved [spontaneously / with a re-entry device — Outback / Pioneer] at the distal SFA / popliteal artery. Balloon angioplasty of the subintimal channel was performed. Stenting was required to maintain patency of the re-entry segment. This technique is appropriate for long SFA occlusions where intraluminal crossing is not feasible and vein bypass conduit is unavailable.

Drug-Coated Balloon (DCB) Angioplasty

Given the femoropopliteal location and lesion characteristics [de novo / restenotic], a drug-coated balloon (paclitaxel-eluting) was used following pre-dilation with a standard balloon. The DCB was inflated for [2–3 minutes] per manufacturer protocol to allow drug transfer to the vessel wall. Stenting was avoided to preserve future bypass options. DCB angioplasty is preferred for femoropopliteal disease to reduce restenosis rates compared to plain balloon angioplasty.

Charting Tips
  • Document the access site hemostasis method. Arteriotomy closure devices (Angioseal, Perclose) require specific documentation of device use and that hemostasis was confirmed before the patient left the table. Manual compression should note duration and that pulses were rechecked.
  • Record runoff vessel status on completion angiography. Number of tibial vessels with runoff to the foot is a key quality metric and affects prognosis. Single-vessel runoff carries higher amputation risk and should be documented.
  • For stent placement, document stent type (self-expanding vs. balloon-expandable), size (diameter × length), and final position. Self-expanding nitinol stents are standard for femoropopliteal disease; balloon-expandable stents are preferred for iliac lesions due to higher radial force.
Billing Tips
  • Code by territory and intervention type: iliac (37220 angioplasty / 37221 stent), femoral-popliteal (37224 angioplasty / 37225 stent), tibial/peroneal (37228 angioplasty / 37229 stent). Each territory is coded separately.
  • Add-on codes for each additional vessel in the same territory: 37222 (iliac), 37226 (fem-pop), 37230 (tibial) for angioplasty; 37223/37227/37231 for stent. Bill one primary + add-ons per additional ipsilateral vessel treated.
  • Bilateral iliac interventions: bill each side separately with -RT/-LT modifiers; bilateral rates apply (150% of the higher rate).
  • Selective catheterization of contralateral iliac or tibial vessels is separately billable with appropriate catheter placement codes (36245–36248). Document each catheterization performed.
  • Global period is 0 days (endoscopic). Follow-up duplex surveillance, ABI checks, and subsequent interventions at different sessions are separately billable.
  • Imaging (fluoroscopy, angiography) is bundled into the interventional codes. Do not separately bill 75716 or 75710 when performed as part of the same peripheral intervention.
  • Document vessel(s) treated with laterality, pre/post intervention lesion characteristics, catheter access site, devices deployed (stent brand, size, length), and clinical response. All are required for medical necessity and coding defensibility.