CPT® Code 0235T

1. Indications

The procedure described by CPT® Code 0235T is indicated for patients experiencing arterial occlusions in visceral arteries, excluding the renal arteries. These occlusions may lead to symptoms such as:

• Peripheral Artery Disease: A condition characterized by narrowed arteries reducing blood flow to the limbs, which can cause pain and discomfort.
• Ischemic Symptoms: Symptoms resulting from insufficient blood supply to the organs, which may include abdominal pain or cramping.
• Angina: Chest pain or discomfort that occurs when the heart muscle does not get enough blood due to narrowed arteries.
• Intermittent Claudication: Pain in the legs or buttocks during physical activity due to inadequate blood flow.

2. Procedure

The procedure for CPT® Code 0235T involves several critical steps to ensure effective treatment of the occluded visceral artery. The following outlines the procedural steps:

• Step 1: Accessing the Artery - The physician begins by preparing the skin over the access artery, which is typically one of the femoral arteries. If an open approach is chosen, an incision is made to expose the artery. In a percutaneous approach, the skin is punctured with a needle to access the artery.
• Step 2: Insertion of Sheath - After accessing the artery, a sheath is placed to facilitate the introduction of other instruments. This sheath serves as a conduit for the guidewire and atherectomy catheter.
• Step 3: Guidewire Placement - Under radiological supervision, a guidewire is inserted through the sheath and advanced from the access artery to the occluded visceral artery. This step is crucial for navigating the vascular system.
• Step 4: Atherectomy Catheter Advancement - The atherectomy catheter is then advanced over the guidewire. Once in position, the guidewire is withdrawn, allowing the atherectomy device to perform its function.
• Step 5: Performing Atherectomy - The atherectomy device, equipped with a specialized balloon catheter and a cutting piston, is utilized to shave plaque from the arterial wall. The cutting piston advances through a window on the catheter, effectively removing the plaque and pushing it into the device for removal.
• Step 6: Completion Angiography - After the atherectomy is performed, the atherectomy device is exchanged for a guidewire, and an angiography catheter is advanced over the guidewire. Contrast material is injected to visualize the artery, and completion angiography is conducted to confirm that the artery is patent.
• Step 7: Closure of Access Site - Upon completion of the procedure, if an open approach was used, the access artery is repaired, and the skin incision is closed. In the case of a percutaneous approach, 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, patients may require specific post-procedure care to ensure proper recovery. If an open approach was utilized, the access site will need to be monitored for signs of infection or complications, and the skin incision will be closed appropriately. In the case of a percutaneous approach, it is essential to apply pressure to the puncture site to prevent bleeding and to place a pressure dressing to support healing. Patients may be advised to limit physical activity for a short period following the procedure to promote healing and reduce the risk of complications. Follow-up appointments may be scheduled to assess the success of the procedure and to monitor the patient's recovery and overall vascular health.