CPT® Code 0234T

1. Indications

The procedure described by CPT® Code 0234T is indicated for patients who have significant atherosclerotic disease affecting the renal artery, which may lead to renal artery stenosis. This condition can result in hypertension, renal insufficiency, or other complications related to impaired blood flow to the kidneys. The atherectomy is performed to alleviate these symptoms and restore normal blood flow, thereby improving renal function and overall patient health.

2. Procedure

The procedure begins with the physician selecting the appropriate approach, either open or percutaneous, to access the renal artery. In the open approach, the skin over the access artery is prepared and incised, allowing the physician to expose the artery directly. A small nick is made in the artery, and a sheath is placed to facilitate the introduction of instruments. In contrast, the percutaneous approach involves preparing the skin over the access artery, typically one of the femoral arteries, and puncturing it with a needle to insert a sheath. Once access is achieved, radiological supervision is employed to guide the next steps. A guidewire is inserted through the sheath and advanced from the access artery to the occluded renal artery. The atherectomy catheter is then advanced over the guidewire, and the guidewire is withdrawn. The atherectomy catheter is equipped with a specialized balloon and a cutting piston that shaves plaque from the arterial wall as it is advanced. The shaved plaque is collected in the device's nose and removed when the catheter is withdrawn. The physician may perform multiple passes with the atherectomy device to ensure thorough plaque removal. After the atherectomy is completed, the atherectomy device is exchanged for a guidewire, and an angiography catheter is advanced over the guidewire. Contrast material is injected to perform a completion angiography, confirming that the renal artery is patent. Finally, the angiography catheter is withdrawn, and the procedure concludes with closure of the access site. If the open approach was used, the access artery is repaired, and the skin incision is closed. If the percutaneous approach was utilized, pressure is applied to the puncture site to control bleeding, followed by the application of a pressure dressing.

3. Post-Procedure

After the completion of the atherectomy procedure, post-procedure care is essential to ensure patient safety and recovery. If an open approach was utilized, the physician will repair the access artery and close the skin incision, monitoring the site for any signs of complications such as bleeding or infection. In the case of a percutaneous approach, pressure is applied to the puncture site to control any bleeding, and a pressure dressing is applied to maintain hemostasis. Patients are typically monitored for vital signs and any potential complications in a recovery area. Follow-up care may include imaging studies to assess the success of the procedure and ongoing management of any underlying conditions, such as hypertension or renal insufficiency. Patients may also receive instructions regarding activity restrictions and signs of complications to watch for as they recover.