new surgical indications 2018 for intervention/carotid...

new surgical indications 2018 for intervention/carotid

stenting indications

George H. Meier, MD RVT FACSProfessor and Chief, VascularUniversity of Cincinnati COM

Disclosures

None

Outline• Overview of new CPT codes for 2018

• TCAR

• Venous Closure– Venaseal– Varithena

• Apthus

CPT codes for 2018

• Completely revamped Endovascular Repair (EVR) codes:– Ruptured EVR codes– Enhanced fixation codes– Percutaneous access codes

• Revalued sclerotherapy codes• New codes for venous ablations:

– Adhesive glue– Ultrasound guided foam

TRANSCAROTID ARTERY REVASCULARIZATION

• Carotid artery stenting without embolic protection is not covered by Medicare. The ENROUTE Transcarotid NPS used in TCAR procedures provides flow reversal embolic protection, and therefore is defined as carotid artery stenting with embolic protection.

Varithena for Venous Ablation

Polidocanol 1% foam using 65:35 O2:CO2

Varithena for Venous Ablation

• US guided

• No tumescence

• Single mid leg access

• Do not need straight vein!

Issues

• Foam floats!

• Single access in mid-leg

• US guided, no catheter

Venaseal for Venous Ablation

Venaseal for Venous Ablation

• US guided

• No tumescence

• No nerve issues

• Catheter-based delivery system

Venaseal

Venaseal

Conclusions• TCAR is reviving carotid stenting

• New venous ablation techniques have advantages for certain clinical situations

• New codes, but not really any new reimbursement