Summary & Overview
CPT 0235T: Visceral Artery Plaque Removal
CPT code 0235T describes a procedure to restore blood flow in a narrowed or blocked visceral artery (excluding the renal artery) by removing deposited plaque via open or percutaneous techniques. This code captures a narrowly defined vascular intervention that is clinically significant for patients with visceral arterial occlusive disease, affecting blood supply to intra-abdominal organs. Nationally, accurate coding for this procedure supports appropriate tracking of advanced vascular services and informs coverage determinations and hospital billing practices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise review of what CPT code 0235T represents, the clinical context for use, and the typical settings where the service is performed. The publication outlines expected benchmarks and reimbursement considerations, common modifiers used with the code, and implications for hospital and interventional radiology service lines.
The content provides clinical context for coding decisions, summarizes payer coverage patterns and policy nuances at a national level, and highlights operational implications for service lines that perform visceral arterial plaque removal. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0235T describes a procedure in which the provider restores blood flow in a narrowed or blocked visceral artery (excluding the renal artery) by removing deposited plaque through an open or percutaneous approach. This procedure is a form of arterial plaque removal targeting visceral arteries that supply intra-abdominal organs.
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Service type: Vascular plaque removal for visceral arteries (open or percutaneous)
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Typical site of service: Hospital operating room or interventional radiology suite (inpatient or outpatient hospital settings)
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with progressive postprandial abdominal pain, unintentional weight loss, and imaging-confirmed high-grade stenosis of the superior mesenteric artery presents for revascularization. The interventional vascular surgery or interventional radiology team evaluates the patient in preoperative clinic, reviews CTA of the abdomen demonstrating atherosclerotic plaque causing critical luminal narrowing of a visceral artery (excluding renal arteries), and confirms medical optimization including antiplatelet therapy and assessment of comorbid conditions. On the day of service the patient is brought to an endovascular suite or hybrid operating room. Under conscious sedation or general anesthesia, vascular access is obtained percutaneously (common femoral or brachial access) and angiography is performed to localize the lesion. The provider performs plaque removal via percutaneous mechanical thrombectomy/atherectomy or open endarterectomy as indicated to restore flow to the affected visceral artery. Completion angiography confirms improved luminal diameter and distal perfusion. Post-procedure the patient is monitored in a post-anesthesia care unit or inpatient ward for hemodynamic stability, access site complications, and bowel function, with plans for antiplatelet therapy and follow-up vascular imaging as appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |
22 | Increased procedural services | Use when work required is substantially greater than typical for the procedure |
23 | Unusual anesthesia | Use when general anesthesia is administered solely because of the procedure's unusual circumstances |
50 | Bilateral procedure | Use if bilateral visceral interventions are reported and payer accepts bilateral modifier for the service (rare for visceral arteries) |
51 | Multiple procedures | Use when multiple distinct procedures are performed during the same session |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances after anesthesia is administered |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons |
66 | Surgical team | Use when a surgical team reports a procedure performed by multiple team members |
78 | Unplanned return to OR | Use when the patient returns to the operating room for a related procedure during the postoperative global period |
80 | Assistant surgeon | Use when an assistant surgeon is required and billing for assistant is appropriate |
81 | Minimum assistant surgeon | Use when a minimal assistant surgeon service is provided and meets payer criteria |
82 | Assistant not available | Use when assistant surgeon is not available and a qualified resident or other qualified provider assists under payer policy |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare | Use to identify services furnished by these non-physician practitioners when allowed |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208100000X | Vascular Surgery | Primary specialty performing open and endovascular visceral artery interventions |
| 208800000X | Interventional Radiology | Commonly performs percutaneous visceral artery revascularization and atherectomy |
| 207RP1001X | Cardiac/Thoracic Vascular Surgery | Vascular procedures within a hybrid OR setting |
| 3336C0005X | Interventional Cardiology | May perform complex endovascular visceral procedures in select centers |
| 207L00000X | General Surgery | May perform open visceral arterial endarterectomy in surgical practice |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K55.0 | Acute vascular disorders of intestine | Acute mesenteric ischemia may require urgent visceral artery revascularization |
K55.1 | Chronic vascular disorders of intestine | Chronic mesenteric ischemia is a common indication for restoring visceral arterial blood flow |
I70.2 | Atherosclerosis of native arteries of the extremities (used as proxy for atherosclerosis elsewhere) | Atherosclerotic disease process that commonly involves visceral arterial plaque formation necessitating plaque removal |
I74.3 | Embolism and thrombosis of mesenteric arteries | Embolic occlusion of a visceral artery that may require thrombectomy/atherectomy to restore perfusion |
I82.402 | Acute embolism and thrombosis of unspecified deep veins of lower extremity (example thromboembolic disease) | Systemic thromboembolic risk factors that may precipitate visceral arterial occlusion and influence peri-procedural management |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36247 | Selective catheter placement, visceral, with angiography, selective, radiological supervision and interpretation | Diagnostic angiography of the visceral artery performed before or during revascularization to localize lesion and guide therapy |
35476 | Transluminal balloon angioplasty, percutaneous, of iliac artery; with or without stent | Endovascular vessel dilation/stent placement techniques that may be performed adjunctively if angioplasty/stent is required after plaque removal |
37226 | Transcatheter placement of an intravascular stent(s), open or percutaneous, visceral/renal artery | Stent placement in a visceral artery when residual stenosis or dissection requires scaffolding following plaque removal |
0236T | Same-day or subsequent percutaneous or open revascularization, renal artery (Note: renal artery specific) | Related revascularization code for renal arteries; clinically analogous for renal interventions though 0235T excludes renal arteries |
35831 | Endarterectomy, other than carotid, with patch graft | Open surgical endarterectomy technique that may be used when plaque removal is performed via open approach |