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Endovascular temporary balloon arterial occlusion is a specialized medical procedure utilized in the head or neck region, specifically targeting both extracranial and intracranial arteries. This technique involves the temporary occlusion of an artery using a balloon, which is crucial for assessing the feasibility of a subsequent permanent occlusion without risking neurovascular complications, such as stroke. The procedure begins with the selection and puncture of an access artery, followed by the placement of an introducer sheath. This sheath facilitates the introduction of a guidewire, which is navigated to the target vessel under fluoroscopic guidance. A neuroangiography catheter is then advanced over the guidewire, allowing for diagnostic angiography to be performed. This step is essential for confirming any vascular anomalies and evaluating the surrounding vasculature prior to the balloon occlusion. Once the diagnostic phase is complete, the catheter is positioned in the artery intended for occlusion. A guidewire is reintroduced, and the angiography catheter is replaced with a temporary balloon occlusion catheter. Prior to the balloon's deployment, a neurological examination is conducted to ensure the patient's stability. Intra-arterial pressure measurements are taken to assess the hemodynamic status of the target vessel. The balloon is then inflated, effectively occluding the artery, and contrast material is injected to verify the occlusion. Following this, arterial pressures are measured again, and another neurological examination is performed to confirm that the patient remains neurologically stable. Over the next 30 minutes, timed neurological evaluations and arterial pressure measurements are conducted to monitor for any changes in neurological status. After this observation period, the temporary occlusion balloon is deflated and removed, and a completion angiogram is performed to rule out any vascular injury that may have occurred during the temporary occlusion procedure.
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The endovascular temporary balloon arterial occlusion procedure is indicated for several specific clinical scenarios, primarily aimed at assessing the safety of permanent arterial occlusion. The following conditions may warrant this procedure:
The endovascular temporary balloon arterial occlusion procedure involves several critical steps that ensure the safe and effective occlusion of the targeted artery. The following procedural steps are performed:
Following the endovascular temporary balloon arterial occlusion procedure, careful monitoring is essential. The patient is observed for any signs of neurological compromise or changes in arterial pressure. The completion angiogram serves to confirm that no vascular injury has occurred as a result of the temporary occlusion. Depending on the findings from the procedure and the patient's overall condition, further interventions may be planned. Continuous neurological assessments are crucial during the recovery phase to ensure the patient's safety and stability.
| Short Descr | ENDOVASC TEMPORY VESSEL OCCL | Medium Descr | EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK | Long Descr | Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic supervision and interpretation of all angiography required for balloon occlusion and to exclude vascular injury post occlusion | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | 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) | 1 - Statutory 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 | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 2 | CCS Clinical Classification | 59 - Other OR procedures on vessels of head and neck |
This is a primary code that can be used with these additional add-on codes.
| 37252 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) | 37253 | Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure) | 69990 | Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) |
| 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2003-01-01 | Added | First appearance in code book in 2003. |
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