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Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries is a specialized medical procedure primarily aimed at treating pulmonary artery hypertension. This technique involves the use of ultrasound energy to denervate the nerves that supply the pulmonary arteries, which can help alleviate the symptoms associated with this condition. The procedure is performed through a minimally invasive approach, utilizing a catheter that is inserted into the right side of the heart. This is achieved via right heart catheterization, which allows for direct access to the pulmonary arteries. Imaging guidance is employed throughout the procedure to ensure accurate placement of the catheter and to monitor the delivery of ultrasound energy. The use of antiplatelet and anticoagulant medications is critical during the procedure to prevent thrombus formation, which can occur due to the manipulation of the vascular structures. The overall goal of this intervention is to improve hemodynamic parameters and enhance the quality of life for patients suffering from pulmonary artery hypertension.
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The procedure is indicated for patients suffering from pulmonary artery hypertension, a condition characterized by elevated blood pressure in the pulmonary arteries, which can lead to significant morbidity and mortality. The primary goal of this intervention is to alleviate symptoms associated with this condition and improve overall hemodynamic function.
The procedure begins with right heart catheterization, which is essential for accessing the pulmonary arteries. A guide catheter is carefully threaded through the sheath over a guidewire and advanced into the pulmonary artery. During this step, hemodynamic measurements of the artery are taken to assess the pressure and flow dynamics. Once the catheter is in place, an activated clotting target time of 245 seconds is verified to ensure adequate anticoagulation before proceeding. Following this verification, a specialized ultrasound treatment catheter is introduced into the pulmonary artery over the guidewire, and its position is confirmed through imaging techniques such as fluoroscopy. The therapeutic ultrasound energy is then delivered to denervate the pulmonary artery, with the treatment duration being less than one minute. The number of treatment sites varies based on the arterial anatomy, but typically, around eight sites within the right and main pulmonary arteries and two sites in the left pulmonary artery are targeted. The ultrasound treatment catheter is moved to each new treatment site, and its position is verified via fluoroscopy before the ultrasonic energy is applied. After all designated lesion sites have been treated, the catheters are removed, and hemostasis is confirmed to ensure that there is no bleeding at the catheter insertion site.
After the completion of the procedure, patients are monitored for any immediate complications, including bleeding or changes in hemodynamic status. Hemostasis at the catheter insertion site is confirmed to prevent any post-procedural bleeding. Patients may be observed for a period to ensure stability before being discharged. Follow-up care may include monitoring for symptom improvement and any potential side effects from the procedure. It is essential to continue the prescribed antiplatelet and anticoagulant therapy as directed to minimize the risk of thrombus formation following the intervention.
| Short Descr | PERQ TCAT US ABLTJ NRV P-ART | Medium Descr | PERQ TCAT US ABLATION NERVES INNERVATING P-ART | Long Descr | Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance | 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) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | 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 | Hospital Part B services paid through a comprehensive APC | 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 |
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| 2023-07-01 | Note | Additional guideline released on AMA website 2022-12-29 with effective date of 2023-07-01. |
| 2021-01-01 | Added | Code added. |
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