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Endovascular venous arterialization of the tibial or peroneal vein is a specialized medical procedure aimed at restoring blood flow in patients experiencing chronic occlusion or failed attempts at revascularization. This condition often results in persistent pain and nonhealing ulcers, significantly impacting the patient's quality of life. The procedure involves the placement of intravascular stent grafts, which are designed to facilitate blood flow through the affected veins. Access to the common femoral artery on the same side is achieved, allowing for the insertion of a sheath that is advanced to the target artery, typically the posterior tibial artery. Through the use of arteriography with contrast, the physician can visualize the obstruction or site of occlusion, which is critical for planning the intervention. The procedure employs a series of catheterizations and imaging guidance to ensure precision and effectiveness in creating a new pathway for blood flow. By utilizing advanced techniques such as balloon dilation and the deployment of stent grafts, the procedure aims to establish a permanent arteriovenous connection, ultimately improving circulation to the foot and alleviating symptoms associated with venous occlusion.
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The endovascular venous arterialization procedure is indicated for patients with specific conditions that necessitate the restoration of blood flow in the lower extremities. These indications include:
The endovascular venous arterialization procedure involves several critical steps to ensure successful intervention. The steps are as follows:
Post-procedure care involves monitoring the patient for any complications and ensuring that the newly established blood flow is effective. Patients may require follow-up imaging to assess the patency of the stent grafts and the success of the arterialization. Additionally, healthcare providers will evaluate the patient's symptoms and overall recovery, providing necessary interventions or adjustments to treatment as needed. It is essential to educate patients on signs of complications, such as increased pain or swelling, and to schedule regular follow-up appointments to monitor their condition.
| Short Descr | EVASC VEN ARTLZ TIBL/PRNL VN | Medium Descr | ENDOVASCULAR VENOUS ARTERIALIZATION TIBL/PRNL VN | Long Descr | Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | 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 | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - 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 | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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| 2021-01-01 | Added | Code added. |
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