CPT® Code 0337T | Case2Code

Code deleted, see 93998

Official Description

Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (eg, brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral

Common Language Description

The endothelial function assessment is a diagnostic procedure that evaluates the performance of the endothelial membrane, which is a thin layer of cells lining the interior of blood vessels and the heart. This membrane plays a crucial role in regulating vascular relaxation and contraction, as well as in the management of blood clotting, immune responses, and platelet adhesion. Dysfunction of the endothelium can be indicative of cardiovascular risk factors and is often associated with conditions such as coronary artery disease. The assessment is conducted using non-invasive techniques that measure the peripheral vascular response to reactive hyperemia, which refers to the temporary increase in blood flow to an organ following a brief period of reduced blood supply (ischemia). There are two primary methods employed for this assessment: high-resolution ultrasound of the brachial artery and peripheral artery tonometry. The brachial artery ultrasound technique involves capturing longitudinal images of the artery to establish a baseline measurement. A blood pressure cuff is then inflated to a level above systolic pressure for a duration of five minutes to induce ischemia, after which the flow-mediated dilation of the artery is measured. In contrast, peripheral artery tonometry utilizes pneumatic probes placed on the index fingers to establish a baseline pulse wave amplitude. Following the application of a blood pressure cuff to one arm, the pulse wave amplitude is measured and compared between the hyperemic finger and the contralateral, non-ischemic finger. This assessment can be performed unilaterally or bilaterally, providing valuable insights into endothelial function and cardiovascular health.

1. Indications

The endothelial function assessment is indicated for the evaluation of endothelial health and is particularly useful in the following scenarios:

Cardiovascular Risk Assessment This procedure is performed to assess the risk of cardiovascular diseases by evaluating endothelial function, which can be affected by various risk factors.
Monitoring of Coronary Artery Disease It is utilized in patients with known coronary artery disease to monitor changes in endothelial function over time.
Evaluation of Peripheral Vascular Disease The assessment helps in understanding the vascular response in patients with peripheral vascular disease.
Assessment of Diabetes Impact It is indicated for patients with diabetes, as endothelial dysfunction is commonly associated with this condition.

2. Procedure

The endothelial function assessment involves a series of well-defined procedural steps to ensure accurate measurement of endothelial health.

Step 1: Preparation The patient is positioned comfortably, and the appropriate equipment, including a high-resolution ultrasound device or peripheral artery tonometry probes, is prepared for use. The patient's arms are exposed for the procedure.
Step 2: Baseline Measurement For the brachial artery ultrasound method, a baseline measurement is taken by capturing longitudinal ultrasound images of the brachial artery. In the case of peripheral artery tonometry, pneumatic probes are placed on the index fingers of both hands to establish a baseline pulse wave amplitude.
Step 3: Inducing Ischemia A blood pressure cuff is applied above the ultrasound transducer or to one arm and inflated to a supra-systolic pressure for a duration of five minutes. This step induces ischemia, temporarily restricting blood flow to the area.
Step 4: Reactive Hyperemia Measurement After the ischemic period, the blood pressure cuff is released, allowing blood flow to return to the area. For the brachial artery ultrasound, the percent flow-mediated dilation is assessed and calculated after 60 seconds of reactive hyperemia. In the peripheral artery tonometry method, the pulse wave amplitude is measured in the hyperemic finger and compared to the baseline and the contralateral, non-ischemic finger.
Step 5: Data Analysis The results from both methods are analyzed to determine the endothelial function, providing insights into the vascular health of the patient.

3. Post-Procedure

After the endothelial function assessment, patients may resume normal activities immediately, as the procedure is non-invasive and does not typically require any recovery time. It is important for healthcare providers to discuss the results with the patient, explaining the implications of the findings on their cardiovascular health. Follow-up appointments may be scheduled to monitor changes in endothelial function over time, especially for patients with existing cardiovascular risk factors or conditions. Additionally, any necessary lifestyle modifications or treatments may be recommended based on the assessment results.

Short Descr	ENDOTHEL FXNASSMNT NON-INVAS
Medium Descr	ENDOTHELIAL FUNCTION ASSESSMENT NON-INVASIVE
Long Descr	Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (eg, brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	STV-Packaged Codes
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	T2D - Other tests - other
MUE	Not applicable/unspecified.