37224

Revascularization of Femoral/Popliteal Artery with Angioplasty

CPT code 37224 describes an endovascular revascularization procedure performed on the femoral and popliteal arterial territory, which for coding purposes is treated as a single vessel segment. This procedure is indicated for patients with peripheral artery disease (PAD) exhibiting symptoms such as intermittent claudication, rest pain, or tissue loss including ulcers or gangrene. The femoral/popliteal territory includes the superficial femoral artery (SFA), the profunda femoris artery, and the popliteal artery. The procedure begins with obtaining vascular access, typically through a percutaneous puncture of the common femoral artery using the Seldinger technique. Once access is established, a guidewire and catheter are advanced under fluoroscopic guidance to the target site. The procedure includes selective catheterization of the vessel and diagnostic angiography or roadmapping within the treatment zone to identify the location and severity of the stenosis or occlusion. The core of the 37224 procedure is transluminal angioplasty, which involves advancing a balloon catheter across the lesion and inflating it to a specific pressure to dilate the vessel lumen. This mechanical expansion compresses the atherosclerotic plaque and stretches the arterial wall to improve distal blood flow. After the angioplasty is completed, post-intervention angiography is performed to assess the result and ensure adequate luminal gain. The code 37224 also includes all necessary closure of the access site, whether through manual pressure or the use of a vascular closure device. If a stent is placed or atherectomy is performed in the same territory during the same session, 37224 is not reported; instead, the more comprehensive codes such as 37225, 37226, or 37227 are used according to the coding hierarchy.

Clinical Indications

  • Atherosclerosis of the lower extremity with intermittent claudication
  • Critical limb ischemia (CLI) with rest pain
  • Chronic limb-threatening ischemia with non-healing ulcers or gangrene
  • Stenosis of the femoral or popliteal artery exceeding 50% with hemodynamic significance
  • Failure of conservative management for peripheral artery disease symptoms
  • Acute or subacute arterial occlusion needing revascularization

Procedure Steps

  1. Obtain vascular access via percutaneous puncture (e.g., retrograde contralateral or antegrade ipsilateral).
  2. Insert a vascular sheath and advance a guidewire under fluoroscopic guidance.
  3. Perform selective catheterization of the femoral or popliteal artery.
  4. Execute diagnostic angiography or roadmapping within the treatment zone to visualize the lesion.
  5. Traverse the stenotic or occluded segment with a specialized guidewire.
  6. Select an appropriately sized angioplasty balloon based on vessel diameter.
  7. Advance and position the balloon catheter across the lesion.
  8. Inflate the balloon to the manufacturer-recommended pressure to dilate the artery.
  9. Perform post-angioplasty angiography to evaluate flow and luminal improvement.
  10. Remove the catheter and sheath, then achieve hemostasis using manual compression or a closure device.

Coding Guidelines

  • Report 37224 only once per territory (femoral/popliteal) regardless of the number of lesions treated in that territory.
  • The femoral/popliteal territory is defined as a single segment including the superficial femoral artery, profunda femoris, and popliteal artery.
  • Code 37224 is a 'base' code for angioplasty; if atherectomy (37225) or stenting (37226) is performed in the same territory, do not report 37224.
  • Work included in 37224: selective catheterization, diagnostic imaging within the treatment zone, and site closure.
  • Diagnostic angiography of a different territory (e.g., iliac) may be reported separately if no prior study is available.
  • Use modifier 50 for bilateral procedures performed during the same operative session.

Associated ICD-10 Codes