October 2016 Q & A

Question: Femoral Stent to Stop Bleeding

A patient had a TAVR procedure and had continued bleeding of the femoral artery, so a femoral artery stent was deployed. What code do I use for this service? I see that the CPT book states, "Codes 37220-37235 are to be used to describe lower extremity endovascular revascularization services performed for occlusive disease," so I know that these codes do not apply since the stent was deployed for hemostasis. Is this a billable service?
Answer:
I would recommend using CPT code 37236 for the placement of a stent (or stentgraft) when the device is placed to treat a bleeding vessel. Had this hemorrhaging vessel been somehow treated with coils, it would be coded as an embolization with CPT code 37244. If both coils and a stent were used to treat the same pathology, we would only code for the embolization. Code 37226 is for placement of a stent in the femoral/popliteal region for the treatment of occlusive disease, while code 37236 is used when a stent or stentgraft is placed for the treatment of non-occlusive disease (bleeding, AVM, AV fistula, aneurysm or psuedoaneurysm [except in the iliacs where 34900 is used]).