CPT® Code 0505T

Official Description

Endovenous femoral-popliteal arterial revascularization, 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, with crossing of the occlusive lesion in an extraluminal fashion

Common Language Description

Endovenous femoral-popliteal arterial revascularization is a specialized medical procedure aimed at restoring blood flow in the lower limbs, particularly when there is significant obstruction due to conditions such as atherosclerosis or other forms of peripheral vascular disease (PVD). This procedure involves the transcatheter placement of intravascular stent grafts, which are devices designed to support and maintain the patency of the affected arteries. The femoral and popliteal arteries are critical vessels that supply blood to the legs and feet, and their obstruction can lead to severe symptoms including leg pain, numbness, non-healing wounds, and even gangrene. The procedure can be performed using either percutaneous or open vascular access techniques, depending on the specific clinical scenario and the patient's condition. During the intervention, ultrasound guidance may be utilized to enhance the accuracy of vascular access, while fluoroscopy may be employed for real-time imaging throughout the procedure. The approach can be antegrade, accessing the common femoral artery from the groin, or retrograde, accessing the popliteal artery from the back of the knee. The process involves several critical steps, including the insertion of an introducer sheath into the artery, the use of a guidewire to navigate to the site of occlusion, and the deployment of a balloon catheter to open the blocked vessel. If necessary, stent grafts are placed to ensure that the artery remains open and functional. The entire procedure is conducted under careful radiological supervision, ensuring that all imaging and roadmapping requirements are met to facilitate a successful outcome. Ultimately, this intervention is crucial for patients suffering from lower limb ischemia, as it can significantly improve their quality of life and prevent serious complications associated with inadequate blood flow.

1. Indications

Lower Limb Ischemia Endovenous femoral-popliteal arterial revascularization is indicated for patients experiencing lower limb ischemia due to atherosclerosis or other peripheral vascular diseases (PVD) that impair blood flow to the legs and feet.

Symptoms of PVD Common symptoms that may warrant this procedure include leg pain, numbness, non-healing wounds, infection, and gangrene, which are indicative of compromised blood circulation.

2. Procedure

Step 1: Patient Positioning The procedure begins with the patient positioned either supine or prone, depending on the access site chosen for the intervention. If accessing the common femoral artery (CFA), the patient is typically placed in a supine position. Conversely, if the popliteal artery is accessed, the patient may be positioned prone to facilitate access to the posterior knee.

Step 2: Vascular Access Access to the chosen artery is achieved through either an incision or a puncture. An introducer sheath is then inserted into the vessel to facilitate subsequent catheterization. This step is critical as it establishes a pathway for the guidewire and treatment catheter.

Step 3: Guidewire Insertion A guidewire is carefully threaded through the introducer sheath and advanced to the level of the occlusion. This guidewire serves as a guide for the treatment catheter, ensuring accurate placement at the site of the blockage.

Step 4: Catheter Placement A treatment catheter is then introduced over the guidewire and navigated to the occlusion site. This catheter is essential for delivering therapeutic interventions to the affected area.

Step 5: Contrast Injection Contrast media may be injected through the catheter to visualize the occlusion and confirm the catheter's position. This imaging step is crucial for assessing the extent of the blockage and planning the subsequent steps of the procedure.

Step 6: Balloon Angioplasty A balloon catheter is introduced through the working catheter and inflated at the site of the occlusion. This inflation serves to open the blocked vessel, restoring blood flow. After the balloon is inflated and the vessel is opened, the balloon catheter is removed.

Step 7: Stent Graft Placement If necessary, to maintain the patency of the opened vessel, an intravascular stent graft may be delivered through the working catheter to the treated area. This stent graft acts as a scaffold to keep the artery open and prevent re-occlusion.

Step 8: Final Imaging and Closure After the stent graft placement, contrast media is again injected to verify the patency of the vessel and the proper positioning of the graft. Once confirmed, the catheter is removed, and the skin puncture or incision is closed using an appropriate method.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications and ensuring that the access site is healing properly. Patients may be advised on activity restrictions and follow-up appointments to assess the success of the revascularization and the condition of the stent graft. It is essential to provide education on recognizing signs of complications, such as increased pain, swelling, or changes in skin color in the affected limb, which may indicate issues with blood flow or infection.

Short Descr	EV FEMPOP ARTL REVSC
Medium Descr	EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR
Long Descr	Endovenous femoral-popliteal arterial revascularization, 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, with crossing of the occlusive lesion in an extraluminal fashion
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)	0 - No 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
Berenson-Eggers TOS (BETOS)	none
MUE	1

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.
80	Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82	Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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)
RT	Right side (used to identify procedures performed on the right side of the body)