37244

Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation

The CPT code 37244 denotes a highly specialized, minimally invasive endovascular procedure designed to achieve vascular embolization or occlusion specifically for the treatment of arterial hemorrhage, venous hemorrhage, or lymphatic extravasation. This comprehensive code encompasses not only the surgical and technical aspects of deploying embolic agents but also integrates all associated radiological supervision and interpretation, intraprocedural roadmapping, and necessary imaging guidance required to successfully complete the intervention. Embolization is a critical therapy for patients experiencing active, potentially life-threatening bleeding that cannot be managed conservatively. During the procedure, the interventional radiologist, vascular surgeon, or endovascular specialist gains percutaneous access to the vascular system, frequently via the common femoral, radial, or brachial artery. Using real-time fluoroscopic guidance, a guidewire and diagnostic catheter are meticulously advanced through the arterial or venous tree toward the suspected source of bleeding. Diagnostic angiography is then performed to precisely localize the exact site of hemorrhage, which is typically characterized radiographically by direct contrast extravasation, the presence of a pseudoaneurysm, or early venous opacification indicating an arteriovenous fistula. Once the target vascular territory is identified, a microcatheter is coaxially advanced over a steerable microwire to selectively or superselectively cannulate the actively bleeding vessel while sparing healthy surrounding tissue. Embolic materials, which are selected based on the vessel size and flow dynamics and may include metallic pushable or detachable coils, gelatin sponge, polyvinyl alcohol particles, calibrated microspheres, or liquid embolic agents, are then meticulously deployed into the target vessel to effectively occlude blood flow and arrest the hemorrhage permanently. Following the successful deployment of the embolic material, a completion angiogram is performed to verify the complete cessation of bleeding and ensure the preservation of physiological blood flow in adjacent, non-target vessels. Finally, the catheters and sheaths are completely removed from the patient, and reliable hemostasis is carefully achieved at the percutaneous access site utilizing manual compression or an FDA-approved vascular closure device. This critical, technically demanding intervention is frequently performed in acute emergency settings for life-threatening conditions such as massive gastrointestinal bleeding, severe traumatic solid organ injuries including deep splenic or hepatic lacerations, catastrophic postpartum hemorrhage, or intractable hemoptysis, offering a highly effective, rapid, and life-saving alternative to traditional open surgical exploration.

Clinical Indications

  • Massive or refractory gastrointestinal hemorrhage
  • Traumatic solid organ injury with active bleeding (e.g., spleen, liver, kidney)
  • Severe postpartum hemorrhage unresponsive to medical management
  • Intractable hemoptysis requiring bronchial artery embolization
  • Pelvic fracture with associated arterial bleeding
  • Ruptured pseudoaneurysm
  • Retroperitoneal hematoma with active extravasation

Procedure Steps

  1. Obtain percutaneous vascular access using ultrasound guidance at the femoral, radial, or brachial artery.
  2. Insert an introducer sheath and advance a base catheter over a guidewire into the aorta or major regional vessel.
  3. Perform initial diagnostic angiography to map the vascular anatomy and identify the exact site of contrast extravasation or hemorrhage.
  4. Advance a microcatheter coaxially over a microwire to selectively or superselectively cannulate the bleeding target vessel.
  5. Confirm catheter position with a localized micro-angiogram.
  6. Deploy appropriate embolic agents (such as microcoils, particles, or liquid embolic materials) into the bleeding vessel until stasis is achieved.
  7. Perform a post-embolization completion angiogram to confirm the cessation of hemorrhage and evaluate collateral flow.
  8. Withdraw all catheters and the introducer sheath.
  9. Achieve hemostasis at the vascular access site using manual compression or a dedicated closure device.

Coding Guidelines

  • CPT 37244 includes all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance. Do not report guidance codes separately.
  • Code 37244 is reported once per surgical site or operative field, regardless of the number of vessels embolized within that specific field to treat the hemorrhage.
  • Diagnostic angiography may be reported separately only if it is the initial diagnostic study, if the patient clinical condition has changed requiring a new study, or if evaluating a separate vascular territory. Append modifier 59 or XU as appropriate.
  • Selective catheter placement codes (e.g., 36245-36248) are not bundled into 37244 and should be reported separately for the catheter work required to reach the embolization site.
  • Do not report 37244 for embolization of tumors or organ ischemia (use 37242 or 37243 instead).

Associated ICD-10 Codes