Appeal type: Surgery
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 37225, 75710, and 75625 billed for date of 
service March 30, 2022. 
 
You asked the Plan to pay for procedure codes 37225, 75710, and 75625. You say that these codes are 
supported and should be paid. The Plan denied your request. The Plan says procedure codes 37225, 75710, and 
75625 are not supported in the medical record. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
 
 
 
 In this case, the CPT Code Manual definition of code 37225 is Revascularization, endovascular, open or 
percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same 
vessel, when performed.  The CPT Code Manual definition of code 75710 is Angiography, extremity, 
unilateral, radiological supervision and interpretation.  The CPT Code Manual definition of code 75625 is 
Aortography, abdominal, by serialography, radiological supervision and interpretation. 
 
We asked our coder to carefully review the case file and apply the relevant Medicare rules to determine if the 
Plan was correct in denying the request to pay for procedure codes 37225, 75710, and 75625. Our reviewer 
says that procedure codes 37225, 75710, and 75625 are not supported in the medical record. Our reviewer 
found for code 37225, the operative reports:  "Utilizing angled tip catheter and stiff Glidewire, including 
trailblazer catheter, attempt was made to traverse the chronically and totally occluded distal left common 
femoral artery and proximal left superficial femoral artery in antegrade fashion, despite aggressive attempts this 
remained unsuccessful. Additionally, attempt was made to advance the catheter and wire across the totally 
occluded distal left common femoral artery and gain access into the left profunda femoris artery, this remained 
unsuccessful. Next, over the 0.014 inch wire, Bard crosser atherectomy device was utilized to perform 
atherectomy across the occluded distal left common femoral artery/proximal left superficial femoral artery, 
attempt was made to advance the atherectomy device together with the wire across the totally occluded left 
common femoral artery and proximal superficial femoral artery to gain access into the left superficial femoral 
artery lumen while atherectomy was performed. The atherectomy device was retrieved. Subsequent angiogram 
revealed chronically and totally occluded distal left common femoral artery, occluded ostium of the left 
profunda femoris artery, occluded ostium of the left superficial femoral artery, no evidence to suggest vessel 
perforation". The operative report describes unsuccessful attempts for revascularization of occlusion, and 
therefore this procedure code cannot be verified. 
 
For code 75710, the operative report documents:  "Right common femoral artery was evaluated with the 
ultrasound, was noted to be patent with moderate calcific atherosclerotic plaque, local anesthetic was injected, 
right common femoral artery was accessed percutaneously with a micro puncture needle under ultrasound 
guidance, images were saved. The micro puncture sheath was then advanced to the Para renal aortic level, 
aortogram was obtained. Catheter was eventually able to advance transluminal over the wire into the left 
external iliac artery, with the catheter tip placed in the left external iliac artery, left lower extremity angiogram 
was obtained." In this case, the providers plans for intervention were not different from the evaluation 
ultrasound, and therefore this procedure would be inclusive to CPT 27221. 
 
For code 75625, the operative report documents  "Right common femoral artery was evaluated with the 
ultrasound, was noted to be patent with moderate calcific atherosclerotic plaque, local anesthetic was injected, 
right common femoral artery was accessed percutaneously with a micro puncture needle under ultrasound 
guidance, images were saved. The micro puncture sheath was then advanced to the Para renal aortic level, 
aortogram was obtained. Catheter was eventually able to advance transluminal over the wire into the left 
external iliac artery, with the catheter tip placed in the left external iliac artery, left lower extremity angiogram 
was obtained." Per NCCI Policy Manual "The artery is percutaneously punctured with a needle and a guidewire 
is fed through the artery into the abdominal aorta. A catheter is threaded over the guidewire to the point of 
study and the guidewire is removed. Contrast medium is injected and films are taken by serialography, 
producing a series of individual x-ray films. This code reports the radiological supervision and interpretation". 
In this case, operative report does not support per NCCI Policy Manual this procedure has been performed. 
 
 
 
 
 
 
 
 We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of procedure codes 37225, 75710, and 75625 have not been met. Therefore, we 
decided that the Plan does not have to pay for procedure codes 37225, 75710, and 75625 billed for date of 
service March 30, 2022.