Endovascular Revascularization Coding: How to Report a Superior Vena Cava Stent Procedure
Don’t confuse codes for veins with codes for arteries. When your provider performs a percutaneous transcatheter stent placement in the superior vena cava (SVC), it’s essential that you report the service accurately, accounting for all the included elements and avoiding common pitfalls in vascular coding. Read the following scenario to learn how to confidently code this procedure and ensure your claim reflects the full scope of work documented. Recognize the Key Procedure Elements Scenario: The patient was prepped, and anesthesia was administered. The cardiologist employed a percutaneous transcatheter stent placement technique, so they used a small incision to access the vessel through the skin. They advanced a catheter through the vessels toward the area requiring treatment. Next, the cardiologist administered contrast material into the vessel to investigate the exact location and extent of the vascular abnormality. They also performed an angioplasty to prepare the site. With the assistance of a guidewire, the cardiologist inserted the catheter stent system into the lumen of the superior vena cava. The stent was delivered at the site of the vascular occlusion to increase the diameter of the stenosed vessel. The cardiologist used radiological guidance to monitor the stent placement inside the vessel lumen. They withdrew the catheter after the appropriate level of recanalization of the occluded vessel was achieved through the stent delivery. Finally, they closed the access site using an arterial closure device. In this scenario, the physician accessed the vascular system percutaneously, navigated a catheter to the “superior vena cava,” and performed a “diagnostic contrast injection” to evaluate the occlusion. The physician then completed an “angioplasty” to prepare the vessel, followed by “stent deployment” under “radiological guidance.” After confirming recanalization, they closed the access site with an “arterial closure device.” So long as your cardiologist’s documentation supports this code, you should report 37238 (Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein). Why? This code fully captures the procedure because the cardiologist placed the initial stent in a vein (the SVC) and included angioplasty with radiological supervision and interpretation (S&I). If your provider places additional stents in different veins, you should report each additional stent with +37239 (… including angioplasty within the same vessel, when performed). Be cautious: You’ll report multiple stents in the same vein (even across an extended lesion) with only one unit of 37238. CPT® guidelines clarify that treatment of a contiguous lesion extending from one vessel into another with a single therapy should be reported only once. Beware: Arterial vs. Venous Stent Placement You can avoid potential missteps by distinguishing between venous and arterial stent placements. Follow this breakdown: Don’t confuse the two. For example, if your provider had treated the subclavian artery instead of the superior vena cava, you’d use 37236 instead. Codes 37238 and +37239 are comprehensive. You should not separately report: All these elements are bundled into the 37238 code when they occur in the same vessel. What to Look for in Documentation To support reporting CPT® code 37238, verify the following key elements in the op report: By aligning the documentation with these CPT® coding rules, you’ll accurately reflect the full scope of the procedure and avoid common denials. Always read vascular op notes carefully, as they often describe multiple interventions across different vessels — which can make or break the correct use of these complex codes. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
