CPT® Code 0553T

Code Deleted. See 37799.

Official Description

Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention

Common Language Description

The CPT® Code 0553T refers to the procedure of percutaneous transcatheter placement of an iliac arteriovenous anastomosis implant. This innovative intervention is designed to create a direct connection, or conduit, between the high-pressure external iliac artery and the high-capacity external iliac vein. The primary purpose of this procedure is to lower blood pressure in patients who suffer from treatment-resistant hypertension, a condition that does not respond adequately to standard antihypertensive therapies. The procedure is performed in an endovascular catheterization lab, utilizing fluoroscopic guidance to ensure precision and safety throughout the intervention. A small incision is made in the upper thigh or inguinal area, allowing access to the iliac vein. A needle is carefully used to puncture the anterior wall of the iliac vein, followed by the insertion of a deployment catheter that contains a self-expanding nitinol coupler device. This device is advanced through the needle and catheter at a specific angle to facilitate its placement into the iliac artery. Once positioned correctly, the implant is deployed, creating an open channel between the artery and vein, which is crucial for managing blood pressure effectively. After the successful deployment of the implant, both the catheter and needle are withdrawn, and the incision site is closed, completing the procedure.

1. Indications

The procedure described by CPT® Code 0553T is indicated for patients with treatment-resistant hypertension. This condition is characterized by high blood pressure that remains uncontrolled despite the use of multiple antihypertensive medications. The creation of an iliac arteriovenous anastomosis aims to provide an alternative therapeutic approach to manage blood pressure effectively in these patients.

Treatment-Resistant Hypertension Patients who do not achieve adequate blood pressure control with standard medication regimens.

2. Procedure

The procedure involves several critical steps to ensure successful placement of the iliac arteriovenous anastomosis implant.

Step 1: Preparation and Access The patient is positioned appropriately in the endovascular catheterization lab, and the area of the upper thigh or inguinal region is prepared and sterilized. A local anesthetic may be administered to minimize discomfort. A small skin incision is made to provide access to the iliac vein.
Step 2: Vein Puncture A needle is carefully inserted to puncture the anterior wall of the iliac vein. This step is crucial as it establishes the entry point for the deployment catheter.
Step 3: Catheter Insertion The deployment catheter, which contains the self-expanding nitinol coupler device, is then inserted through the needle. The catheter is advanced at a 45-degree angle through the posterior wall of the iliac vein and directed into the iliac artery, ensuring proper positioning for the implant.
Step 4: Implant Deployment Once the catheter is in the correct position, the implant is deployed from the catheter. The nitinol coupler device expands and seats itself into the walls of both the iliac artery and vein, establishing a stable conduit between the two vessels.
Step 5: Closure After successful deployment of the implant, the catheter and needle are withdrawn. The small incision made at the beginning of the procedure is then closed, completing the intervention.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any immediate complications, such as bleeding or infection at the incision site. Patients may be observed for a short period in a recovery area before being discharged. Follow-up appointments are typically scheduled to assess the effectiveness of the implant in managing blood pressure and to monitor for any potential complications related to the procedure. Patients may also receive instructions regarding activity restrictions and signs of complications to watch for during their recovery.

Short Descr	PERQ TCAT ILIAC ANAST IMPLT
Medium Descr	PERQ TCAT PLMT ILIAC ARVEN ANASTOMOSIS IMPLANT
Long Descr	Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.