Peripheral Angioplasty and Stenting (Iliac / Femoral / Tibial)

CPT 37267 · 8.75 wRVU · 0-day global
CPT37267
wRVU8.75
Global0-day
ApproachEndovascular
ComplexityModerate
Add-on / Variant CPTs
  • 37268 wRVU: 3.73 — Revascularization, endovascular, FPVT, stent, straightforward, each additional vessel (true CPT add-on to 37267; 3.73 wRVU, ZZZ global)
  • 37270 wRVU: 5.0 — Revascularization, endovascular, FPVT, stent, complex, each additional vessel (true CPT add-on to 37269; 5.00 wRVU, ZZZ global)
  • 37264 wRVU: 3.0 — Revascularization, endovascular, FPVT, angioplasty, straightforward, each additional vessel (true CPT add-on to 37263; 3.00 wRVU, ZZZ global)
  • 37266 wRVU: 4.0 — Revascularization, endovascular, FPVT, angioplasty, complex, each additional vessel (true CPT add-on to 37265; 4.00 wRVU, ZZZ global)
Preoperative Diagnosis:

Right [left] lower extremity [critical limb ischemia / claudication / rest pain / tissue loss]: [iliac / superficial femoral / popliteal / tibial] 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 a [21-gauge micropuncture / 18-gauge access] needle under ultrasound guidance. A [6 Fr] sheath was placed.

Heparin [70-100 units/kg] was administered intravenously with a target ACT >200-250 seconds; additional heparin was administered as needed. Diagnostic angiography of the [iliac / femoral / popliteal] system was performed in [AP / oblique] projections. The target lesion was identified: [description of lesion: stenosis vs occlusion, 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) for [1-3 months] per SVS guidelines] 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 *** units/kg, ACT ***. Diagnostic angio: *** lesion [stenosis/occlusion]. 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 *** months. 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. Total occlusion supports the complex CPT designation; document "occlusion" explicitly.

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 ostial common iliac lesions where precision deployment is required. For non-ostial external iliac and longer iliac lesions, self-expanding stents demonstrate superior outcomes (ICE trial, JACC CI 2017).
  • ICD-10: I70.211-I70.213 (claudication by laterality), I70.221-I70.223 (rest pain), I70.231-I70.244 (with ulceration), I70.261-I70.268 (with gangrene). I70.92 (chronic total occlusion of artery of extremity) is sequenced as an additional code after the primary atherosclerosis code when CTO is present.
Billing Tips
  • 2026 CPT lower extremity revascularization (LER) codes are organized by vascular territory. Each territory has standalone primary codes (0-day global) for the first vessel and true add-on codes (ZZZ global) for each additional vessel. Iliac territory (IVT): 37254 (angioplasty, straightforward, 7.30 wRVU) / 37256 (complex, 10.75 wRVU) / 37258 (stent, sf, 8.75 wRVU) / 37260 (stent, complex, 12.69 wRVU). Femoropopliteal territory (FPVT): 37263 (angioplasty, sf, 7.75 wRVU) / 37265 (complex, 10.50 wRVU) / 37267 (stent, sf, 8.75 wRVU) / 37269 (stent, complex, 14.75 wRVU). Tibial/peroneal territory (TPVT): 37280 (angioplasty, sf, 9.80 wRVU) / 37282 (complex, 12.31 wRVU) / 37284 (stent, sf, 10.00 wRVU) / 37286 (stent, complex, 13.46 wRVU).
  • Straightforward vs complex: straightforward = any lesion with residual luminal patency (stenosis, even severe); complex = total occlusion (100%, no flow). In-stent restenosis is NOT automatically complex — classify based on whether it is a stenosis (straightforward) or an occlusion (complex). Add-on codes for each additional vessel within the same territory: IVT add-ons +37255/+37257/+37259/+37261; FPVT add-ons +37264/+37266/+37268/+37270; TPVT add-ons +37281/+37283/+37285/+37287. Primary codes carry 0-day global; add-on codes carry ZZZ global (follows the primary's global period).
  • Bilateral iliac interventions: for Medicare, report on a single line with modifier -50 (bilateral); reimbursement is 150% of the unilateral fee schedule amount. Do NOT use -RT/-LT on two separate lines for Medicare — that format applies to some commercial payers only. Verify payer policy before submitting.
  • Selective catheterization codes (36245-36248) are bundled into the 2026 LER primary codes when used to access and cross the treated vessel — the LER descriptors include 'all maneuvers necessary for accessing and selectively catheterizing the artery.' Separate billing of 36245-36248 is appropriate only for diagnostic catheterization of territories that are NOT subsequently intervened on at the same session.
  • Diagnostic lower-extremity arteriography (75710 unilateral, 75716 bilateral) is bundled into the LER interventional codes when performed as routine roadmap angiography during the intervention. However, 75710/75716 are separately reportable with modifier -59 (or -XU) when: (1) no prior catheter-based study is available, (2) a complete diagnostic arteriogram is performed before the intervention decision, and (3) the decision to intervene is based on that diagnostic study. Document all three elements to support separate billing.
  • Global period: primary codes (37254-37294) carry 0-day (endoscopic/minor) global. Add-on codes (37255, 37257, 37259, 37261, 37264, 37266, 37268, 37270, 37281, 37283, 37285, 37287) carry ZZZ global. Follow-up duplex surveillance, ABI checks, and subsequent interventions at different sessions are separately billable.
  • Document vessel(s) treated with laterality, lesion characteristics (straightforward stenosis vs total occlusion, lesion length in cm), catheter access site, devices deployed (stent type, size, length), and clinical response. Straightforward vs complex designation determines the CPT tier and must be explicitly documented — 'occlusion' must appear in the note to support a complex code.

General coding reference. Verify with your institution’s billing department before submitting claims.

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