Cardiology Coding Alert

Question: The patient has carotid artery stenosis, so my cardiologist placed an intravascular stent in the carotid artery to treat the condition. My cardiologist performed the transcatheter stent placement in the intrathoracic common carotid artery. They performed retrograde treatment of a lesion through an open cervical carotid artery approach. I’ve narrowed down my choices to either 37217 or 37218, but I am not sure of the difference between these two codes. Which code should I report for this procedure?

Texas Subscriber

Answer: You should report 37217 (Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation) for this procedure.

The other code you mention is 37218 (Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation). However, code 37217 is the correct code for your scenario because of the approach. Your cardiologist placed the catheter through an open incision of the ipsilateral cervical carotid artery directing the catheter retrograde.

With code 37218, the cardiologist will direct the catheter antegrade through open incision or percutaneous approach to place the stent.

Carotid artery stenosis defined: When a patient has carotid artery stenosis, one or both of the carotid arteries are narrowed, so blood flow to the brain is reduced. This can lead to stroke. Your cardiologist can perform carotid stenting and angioplasty to help reopen the carotid arteries.