CPT® Code 35494

Code deleted, see 0237T.

Official Description

Transluminal peripheral atherectomy, percutaneous; brachiocephalic trunk or branches, each vessel

Common Language Description

The CPT® Code 35494 refers to a specific medical procedure known as transluminal peripheral atherectomy, which is performed percutaneously on the brachiocephalic trunk or its branches. This procedure is primarily indicated for patients with occlusions in these vessels, which can impede blood flow and lead to various complications. The term 'transluminal' indicates that the procedure is conducted within the lumen of the blood vessel, allowing for minimally invasive access. During the procedure, the skin over the access artery, typically one of the brachial arteries, is prepared, and a needle is used to puncture the artery, followed by the placement of a sheath. A guidewire is then inserted and advanced into the occluded artery, facilitating the introduction of an atherectomy catheter. This specialized catheter is equipped with a cutting piston that effectively shaves plaque from the arterial wall, thereby restoring patency to the vessel. The plaque is collected within the device and removed upon completion of the procedure. After the atherectomy, an angiography catheter is used to perform a completion angiography, ensuring that the artery remains open. The procedure concludes with the application of pressure to the puncture site to control bleeding, followed by the placement of a pressure dressing. This code is applicable for each vessel treated during the procedure.

1. Indications

The procedure described by CPT® Code 35494 is indicated for patients experiencing occlusions in the brachiocephalic trunk or its branches. These occlusions can lead to reduced blood flow, which may result in symptoms such as:

Peripheral Artery Disease (PAD) - A condition characterized by narrowed arteries reducing blood flow to the limbs.
Ischemic Symptoms - Symptoms resulting from insufficient blood supply, which may include pain, cramping, or weakness in the arms or shoulders.
Rest Pain - Pain in the limbs that occurs at rest due to inadequate blood flow.
Non-Healing Wounds - Ulcers or sores that do not heal properly due to poor circulation.

2. Procedure

The procedure involves several critical steps to ensure effective treatment of the occluded artery:

Step 1: Preparation The skin over the access artery, typically one of the brachial arteries, is thoroughly prepped to maintain a sterile environment. This preparation is crucial to prevent infection during the procedure.
Step 2: Accessing the Artery A needle is used to puncture the artery, and a sheath is placed to facilitate the introduction of other instruments. This step is essential for gaining access to the vascular system.
Step 3: Guidewire Insertion A guidewire is inserted through the sheath and advanced from the access artery into the occluded artery. The guidewire serves as a pathway for the subsequent catheter.
Step 4: Advancing the Atherectomy Catheter The atherectomy catheter is then advanced over the guidewire. Once in position, the guidewire is withdrawn, allowing the atherectomy device to operate directly on the occlusion.
Step 5: Performing Atherectomy The atherectomy device utilizes a specialized balloon catheter with a cutting piston that shaves plaque from the arterial wall. As the plaque is removed, it is collected in the device for removal at the end of the procedure.
Step 6: Completion Angiography After the atherectomy, the device is exchanged for an angiography catheter. Contrast material is injected, and a completion angiography is performed to confirm that the artery is patent and blood flow is restored.
Step 7: Post-Procedure Care Once the angiography is completed, the angiography catheter is withdrawn. Pressure is applied to the arterial puncture site to control any bleeding, and a pressure dressing is applied to ensure proper healing.

3. Post-Procedure

Post-procedure care involves monitoring the puncture site for any signs of bleeding or complications. The patient may be advised to rest and avoid strenuous activities for a specified period. Follow-up appointments may be scheduled to assess the success of the procedure and to monitor the patient's recovery. It is essential to ensure that the artery remains patent and that the patient does not experience any recurrence of symptoms related to the occlusion.

Short Descr	ATHERECTOMY, PERCUTANEOUS
Medium Descr	TRLUML PRPH ATHRC PRQ BRCH/CPHLC TRNK/BRNCH EA
Long Descr	Transluminal peripheral atherectomy, percutaneous; 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)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory 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	Significant Procedure, Multiple Reduction Applies
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	61 - Other OR procedures on vessels other than head and neck