37238

Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial vein

Current Procedural Terminology (CPT) code 37238 designates the initial transcatheter placement of an intravascular stent, or multiple stents, within a single vein utilizing either an open or percutaneous approach. This comprehensive vascular intervention code intrinsically encompasses several vital components of the procedure: the primary stent deployment, any associated pre-dilation or post-dilation balloon angioplasty performed within the same target vessel, and all related radiological supervision and interpretation (RS&I) required to guide the endovascular intervention safely and accurately. Venous stenting is a critical endovascular therapy primarily indicated for patients suffering from severe venous outflow obstructions that impair normal blood return to the heart. Common clinical scenarios necessitating this procedure include May-Thurner syndrome (also known as iliac vein compression syndrome), acute or chronic deep vein thrombosis (DVT) resulting in significant luminal narrowing or residual stenosis after thrombectomy, post-thrombotic syndrome, central venous stenosis, and malignant compression of major veins such as superior vena cava (SVC) syndrome. During the procedure, the vascular surgeon or interventional radiologist typically gains access to the venous system percutaneously under ultrasound guidance, frequently utilizing the popliteal, femoral, internal jugular, or subclavian vein. A guidewire and catheter system is then carefully navigated through the complex venous anatomy to the exact site of the stenosis or occlusion. Contrast media is injected, and intra-procedural venography is performed to precisely delineate the extent, severity, and morphology of the venous lesion. If the vein is heavily stenosed, pre-dilation using balloon angioplasty may be performed to adequately prepare the vessel for the stent. Subsequently, a self-expanding or balloon-expandable metallic stent is advanced over the guidewire and deployed across the narrowed lesion. The stent provides crucial radial force and a scaffold-like support to keep the vein patent, restoring normal hemodynamics and venous blood flow. Following stent deployment, post-dilation balloon angioplasty is frequently executed to ensure optimal stent apposition against the venous wall. A final completion venogram is performed to confirm adequate flow, proper stent positioning, and the absence of complications such as vessel rupture, dissection, or extravasation. Once optimal results are confirmed, the delivery system is systematically removed, and hemostasis is successfully achieved at the access site using manual compression or a dedicated vascular closure device. By encompassing both the therapeutic mechanical intervention and the crucial imaging guidance, CPT 37238 provides a streamlined reporting mechanism for this vital, minimally invasive vascular procedure.

Clinical Indications

  • May-Thurner syndrome (iliac vein compression syndrome)
  • Acute deep vein thrombosis (DVT) with underlying venous stenosis
  • Chronic deep vein thrombosis (DVT) and residual venous scarring
  • Post-thrombotic syndrome (PTS)
  • Superior vena cava (SVC) syndrome
  • Central venous stenosis or stricture
  • Malignant venous obstruction secondary to tumor compression

Procedure Steps

  1. Administration of local anesthesia and moderate sedation or general anesthesia as clinically indicated.
  2. Ultrasound-guided percutaneous puncture of the access vein (e.g., femoral, popliteal, or jugular vein).
  3. Insertion of an introducer sheath into the accessed vein.
  4. Advancement of a guidewire and selective catheter under fluoroscopic guidance to the target venous lesion.
  5. Injection of contrast material to perform diagnostic or intra-procedural venography to map the lesion morphology.
  6. Optional pre-stent balloon angioplasty to dilate the stenotic segment and prepare the vessel for stent placement.
  7. Advancement and precise deployment of a self-expanding or balloon-expandable intravascular stent across the venous stricture or occlusion.
  8. Optional post-stent balloon angioplasty to ensure full expansion and apposition of the stent against the venous wall.
  9. Performance of a final completion venogram to verify stent patency, correct positioning, and restoration of normal venous blood flow.
  10. Removal of the catheter, guidewire, and sheath followed by application of manual compression or a closure device to achieve hemostasis.

Coding Guidelines

  • CPT 37238 includes all radiological supervision and interpretation (RS&I) required to perform the venous stenting; do not report separate RS&I codes for the stent placement.
  • The code inherently includes any balloon angioplasty performed within the same vein during the same operative session. Do not report venous angioplasty (e.g., 37248) in addition to 37238 for the same vessel.
  • Report 37238 for the initial vein treated. If stents are placed in additional, distinct veins during the same session, report the add-on code 37239 for each additional vein.
  • Diagnostic venography may only be reported separately if it meets the strict criteria for a distinct diagnostic study (e.g., no prior diagnostic study exists, or a change in patient condition necessitates a new study), and must be appended with modifier 59 or an applicable X-modifier.
  • Do not report 37238 for stenting performed within a hemodialysis circuit; refer to codes 36901-36909 for dialysis access interventions.
  • Do not report 37238 for arterial stenting; use 37236 for the initial artery.

Associated ICD-10 Codes