CPT® Code 75658 | Case2Code

Code deleted, use 75710.

Official Description

Angiography, brachial, retrograde, radiological supervision and interpretation

Common Language Description

The procedure described by CPT® Code 75658 refers to angiography of the brachial artery, which is a significant blood vessel located in the upper arm. This procedure involves the use of a radiopaque contrast medium and fluoroscopy to visualize the brachial artery, which is crucial for supplying blood to the arm and hand. The brachial artery extends from the axillary artery and is essential for proper blood circulation in the upper extremity. Angiography is typically indicated for patients who may have conditions such as stenosis, which is a narrowing of the artery, or other issues like injury or blockage that could impede blood flow to the arm. During the procedure, a small incision is made in the inner arm at the elbow crease to access the brachial artery. A fine gauge puncture needle is used to access the artery in a retrograde manner, meaning that the catheter is inserted in the opposite direction of blood flow. Fluoroscopic guidance is employed to ensure accurate placement of the catheter, which is threaded over a guidewire into the desired location within the artery. Once positioned, a high-pressure injection of radiopaque contrast medium is administered, allowing for detailed x-ray imaging of the brachial artery. This imaging helps in diagnosing any abnormalities or conditions affecting the artery. After the imaging is completed, the catheter is removed, and the incision is closed. The code 75658 encompasses the radiologist's role in supervising the procedure, interpreting the findings, and providing a comprehensive written report of the results.

1. Indications

The angiography of the brachial artery, as described by CPT® Code 75658, is indicated for several specific conditions and symptoms that may affect blood flow in the upper extremity. These indications include:

Suspected Stenosis - This condition involves the narrowing of the brachial artery, which can lead to reduced blood flow to the arm and hand.
Injury - Trauma to the upper arm may necessitate an evaluation of the brachial artery to assess for any damage or disruption in blood flow.
Blockage - Any obstruction within the brachial artery that could impede circulation may warrant this angiographic procedure to identify the location and extent of the blockage.

2. Procedure

The procedure for brachial angiography involves several critical steps to ensure accurate visualization of the artery. These steps include:

Step 1: Incision and Access - The procedure begins with the patient positioned comfortably, and an incision is made in the inner arm at the elbow crease. This location is chosen to provide direct access to the brachial artery. A fine gauge puncture needle is then used to access the artery in a retrograde fashion, which means that the catheter will be inserted against the direction of blood flow.
Step 2: Catheter Placement - Under fluoroscopic guidance, a guidewire is carefully maneuvered into the desired location within the brachial artery. A catheter is then threaded over the guidewire, allowing for precise placement within the artery. This step is crucial for ensuring that the contrast medium can be effectively injected into the correct area.
Step 3: Injection of Contrast Medium - Once the catheter is in place, a radiopaque contrast medium is injected retrograde at a high pressure, typically using an automatic injector. This contrast medium enhances the visibility of the brachial artery during imaging.
Step 4: Imaging - X-rays are obtained to visualize the brachial artery and assess for any abnormalities, such as stenosis, injury, or blockage. The fluoroscopy allows for real-time imaging, which aids in the evaluation of blood flow.
Step 5: Conclusion of the Procedure - After the imaging is completed, the catheter is carefully removed from the artery. The incision made at the beginning of the procedure is then closed, ensuring that the site is secure and minimizing the risk of complications.

3. Post-Procedure

Following the brachial angiography procedure, patients may be monitored for any immediate complications, such as bleeding or hematoma at the incision site. It is essential to ensure that the access site is stable and that the patient is comfortable. Patients may be advised to rest the affected arm and avoid strenuous activities for a short period to facilitate healing. Additionally, the results of the angiography will be compiled into a written report by the radiologist, which will include the findings and any recommendations for further management if necessary.

Short Descr	ARTERY X-RAYS ARM
Medium Descr	ANIOGRAPHY BRACHIAL RETROGRADE RS&I
Long Descr	Angiography, brachial, retrograde, radiological supervision and interpretation
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services 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	T-Packaged Codes
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I4B - Imaging/procedure - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	188 - Cerebral arteriogram