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The procedure described by CPT® Code 35458 involves an open transluminal balloon angioplasty specifically targeting the brachiocephalic trunk or its branches. This intervention is performed to alleviate blockages within these critical blood vessels, which are responsible for supplying blood to the arms and head. The process begins with the preparation of the skin over the access artery, followed by an incision to expose the artery. Once the artery is accessed, a small nick is made, and a sheath is inserted to facilitate further procedures. A guidewire is then introduced and navigated through the artery into the brachiocephalic trunk or its branches. A catheter equipped with a balloon tip is advanced over this guidewire to the site of the occlusion. The balloon is inflated, which compresses the plaque against the arterial wall, thereby widening the vessel and restoring blood flow. This inflation may be repeated multiple times to achieve optimal results. After the angioplasty, the catheter is exchanged for a guidewire, and an angiography catheter is used to perform a completion angiography, ensuring that the vessel remains patent after the procedure. Finally, the angiography catheter is removed, the access artery is repaired, and the skin incision is closed. It is important to note that the code 35458 should be used for each vessel treated during this procedure.
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The indications for performing an open transluminal balloon angioplasty of the brachiocephalic trunk or branches include the following:
The procedure consists of several critical steps, each essential for the successful completion of the angioplasty:
Post-procedure care involves monitoring the patient for any complications that may arise following the angioplasty. Patients are typically observed for signs of bleeding or hematoma at the access site. Additionally, they may require follow-up imaging studies to confirm the success of the procedure and to ensure that the vessel remains patent. Instructions regarding activity restrictions and medication management, including antiplatelet therapy, may also be provided to support recovery and prevent future vascular events.
| Short Descr | REPAIR ARTERIAL BLOCKAGE | Medium Descr | TRLUML BALO ANGIOP OPN BRCH/CPHLC TRNK/BRNCH EA | Long Descr | Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 9 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 61 - Other OR procedures on vessels other than head and neck |
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