37197

Transcatheter retrieval, percutaneous, of intravascular foreign body

CPT 37197 describes the percutaneous transcatheter retrieval of an intravascular foreign body from the arterial or venous system. This procedure is performed when an object—such as a fractured central venous catheter, a migrated stent, a lost guide wire fragment, or an embolized embolic coil—becomes lodged in a vessel where it poses a risk of thrombosis, infection, or further migration to the heart or pulmonary vasculature. The procedure is typically performed by an interventional radiologist, cardiologist, or vascular surgeon. The physician begins by obtaining percutaneous access, usually through the common femoral vein or artery, using the Seldinger technique. Under continuous fluoroscopic guidance, a sheath is placed, and a catheter is advanced to the location of the foreign body. Various specialized tools are employed for retrieval, the most common being a loop snare; however, baskets, micro-forceps, or specialized grasping catheters may also be used depending on the shape and position of the object. Once the foreign body is successfully captured, it is either drawn into a large-bore sheath or carefully pulled out through the access site. This code is considered a 'comprehensive' code, meaning it includes all radiological supervision and interpretation (RS&I) and all imaging guidance, such as ultrasound for vascular access or fluoroscopy for device manipulation. The description encompasses the work of navigating to the site, manipulating the retrieval device, capturing the object, and withdrawing it safely from the patient's body.

Clinical Indications

  • Fractured or dislodged central venous catheter (e.g., PICC line, Port-a-cath)
  • Migrated or misplaced intravascular stent
  • Embolized embolic materials such as coils, plugs, or beads that have moved from the target site
  • Fractured guide wire fragments or broken pieces of other interventional equipment
  • Displaced inferior vena cava (IVC) filter that is not intended for routine retrieval
  • Foreign bodies resulting from trauma or penetrating injury that have entered the vascular system

Procedure Steps

  1. Identify the location of the intravascular foreign body using fluoroscopy or other imaging modalities.
  2. Prepare the access site (e.g., groin, neck, or arm) under sterile conditions and administer local anesthesia.
  3. Obtain percutaneous vascular access using a needle and guide wire (Seldinger technique).
  4. Place a vascular sheath of sufficient size to accommodate both the retrieval device and the foreign body.
  5. Advance a catheter and/or retrieval device (e.g., loop snare, basket, or forceps) to the site of the foreign body.
  6. Maneuver the retrieval tool to engage and securely capture the foreign object.
  7. Carefully withdraw the captured object into the sheath or pull it through the vessel to the access point.
  8. Remove the object and the delivery system from the patient's body.
  9. Perform a final angiogram or venogram if necessary to ensure vessel patency and absence of trauma.
  10. Remove the sheath and achieve hemostasis at the access site using manual pressure or a closure device.

Coding Guidelines

  • CPT 37197 includes all imaging guidance and radiological supervision and interpretation (RS&I). Do not report 76937 (ultrasound guidance) or 77001 (fluoroscopic guidance) separately.
  • Do not report 37197 in conjunction with IVC filter retrieval (37193); use 37193 if the foreign body is a filter being removed as planned or for complications.
  • Vascular access and all work associated with the retrieval in the same vessel or a continuous vessel system are included.
  • Catheterization required to reach the foreign body is included in 37197 and should not be reported separately with codes from the 36000-36248 range.
  • If the procedure is performed as a component of a larger embolization or stent placement procedure to fix a complication created during that same session, some payers may consider it bundled; however, if it is a distinct procedure at a different site or for a pre-existing foreign body, it is separately reportable.
  • If the retrieval is unsuccessful despite extensive effort, consider appending modifier 52 (reduced services) or modifier 53 (discontinued procedure).

Associated ICD-10 Codes