PERIPHERAL ARTERIAL DISEASE
CERAB Procedure
Question: What is the CERAB procedure and how is it reported?
Answer: CERAB (covered endovascular reconstruction of aortic bifurcation) is a technique used in the treatment of aorto-iliac occlusive disease. It consists of a covered stent in the aorta, and one covered stent in each of the common iliacs that cover the bifurcation, overlap in the aorta and “kiss” one another (kissing stents). There is no specific CPT® code for the CERAB procedure, so the codes to report for this procedure include the bilateral iliac and the aortic stenting:
37221-50/LT, RT – Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed [used to report the kissing stents in the bilateral common iliac arteries, appending modifier -50 or -LT/RT depending on payer requirements.]
37236-59/XS – 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 [used to report covered stenting of aorta for occlusive disease per CPT® guidelines. Per CCI edits, code 37236 is bundled into code 37221, so depending on payer requirements, modifier -59 or -XS may or may not be needed.]
Stenting of Aorta
Question: What would the appropriate CPT® code for stenting of the aorta to treat atherosclerotic occlusive disease isolated to the aorta?
Answer: Per CPT® guidelines, code 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) is used to report stenting of the aorta to treat atherosclerotic occlusive disease.
pDVA Procedure
Question: What is a percutaneous deep vein arterialization (pDVA) procedure and how is it coded?
Answer: Percutaneous deep vein arterialization (pDVA) procedure is a specialized technique which consists of creation of a surgical fistula between the affected vein and a corresponding artery with a stent, essentially bypassing the venous lesion.
Currently there is a Category III code for femoral-popliteal arterial procedure:
0505T – Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion.
And a Category III code for tibial or peroneal venous procedure:
0620T – Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed
pDVA Endoleak
Question: Patient presents with an endoleak at the proximal anastomosis at the left posterior tibial artery/vein, status post percutaneous deep vein arterialization (pDVA) procedure. Repair was performed with angioplasty and subsequent stenting in the proximal posterior tibial artery and vein at the anastomosis site. What is the code used to report this procedure?
Answer: According to AHA Coding Clinic for HCPCS Second Quarter 2020, the code assignment for this procedure is:
37230 – Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed
For coding purposes, stenting both the posterior tibial artery and vein at the proximal anastomosis is considered one vessel in this case.
