Outcomes for supra-aortic branch vessel stenting in the treatment of thoracic aortic disease

Abstract

In 2014, there are several CPT codes that describe carotid artery stenting based on exactly where the stent is deployed and the approach used for vascular access. The bundled Category III CPT code 0075T (Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation, percutaneous; initial vessel) is used to report antegrade intravascular stent placement in the intrathoracic common carotid or extrathoracic vertebral artery through brachial or femoral percutaneous access. The bundled CPT code 37215 (Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection) only applies to extrathoracic carotid artery stenting, not intrathoracic, and mandates “percutaneous access” in the code description. New in 2014, CPT code 37217 (Transcatheter placement of an intravascular stent(s), intrathoracic common carotid artery or innominate artery by retrograde treatment, via open ipsilateral cervical carotid artery exposure, including angioplasty, when performed, and radiological supervision and interpretation) is used to report retrograde treatment of the intrathoracic common carotid artery and/or the innominate artery through an open cervical carotid artery exposure, where the catheter is advanced from the common carotid artery in the neck toward the aortic arch. The specialty societies believed that in addition to retrograde treatment as described in CPT code 37217, antegrade placement of a stent in the innominate artery or in the intrathoracic common carotid artery was appropriate for Category I status. Therefore, the CPT code descriptions for 0075T and 0076T were altered for 2015 to only include extrathoracic vertebral artery intravascular stent placement. A separate bundled CPT code was created for common carotid stenting in the thoracic cavity. To maintain similarity to CPT code 37217, treatment within this new code will include both the innominate artery and the intrathoracic common carotid artery. In 2015, this new bundled Category I CPT code will become effective. The new CPT code 37218, effective January 1, 2015, states “Transcatheter placement of intravascular stent(s), intrathoracic common carotid artery or innominate artery, open or percutaneous antegrade approach, including angioplasty, when performed, and radiological supervision and interpretation.” Similar to CPT code 37215, this bundled code description includes 90-day global services, all selective catheterization to perform the procedure, prestent angioplasty, poststent angioplasty, and all ipsilateral radiology supervision and interpretation. It is reported once regardless of the number of stents implanted and allows for either percutaneous or open vascular access. Of note, diagnostic catheterization and imaging on the opposite side or within the vertebral arteries is separately reportable. CPT codes 35458 (Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each vessel), 35475 (Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or branches, each vessel), 36221-36227 (Diagnostic Studies of Cervicocerebral Arteries), 37236 (Transcatheter placement of an intravascular stent(s) (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery), and 75962 (Transluminal balloon angioplasty, peripheral artery other than renal, or other visceral artery, iliac or lower extremity, radiological supervision and interpretation) are inherent to the service and cannot be reported with CPT code 37218 in the same session for the ipsilateral carotid artery. Lastly, in 2015, the Category III CPT codes 0075T and 0076T will no longer be applicable for intrathoracic common carotid artery treatment but will still be appropriate for reporting transcatheter placement of extrathoracic vertebral artery stent(s). Their official 2015 code descriptions will state “Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; initial vessel” and “Transcatheter placement of extracranial vertebral artery stent(s), including radiologic supervision and interpretation, open or percutaneous; each additional vessel (List separately in addition to code for primary procedure),” respectively. Also, CPT codes 37215 and 37216 will allow for either “open or percutaneous” vascular access in the 2015 code descriptions, whereas they were only applicable for “percutaneous” vascular access in 2014. Outcomes for supra-aortic branch vessel stenting in the treatment of thoracic aortic diseaseJournal of Vascular SurgeryVol. 60Issue 4PreviewEndovascular options for the treatment of proximal thoracic and arch disease have evolved over the years. In this manuscript, we review the midterm results of fenestrated compared with chimney configurations for proximal aortic aneurysm disease. Full-Text PDF Open Archive