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new surgical indications 2018 for intervention/carotid
stenting indications
George H. Meier, MD RVT FACSProfessor and Chief, VascularUniversity of Cincinnati COM
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Disclosures
None
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Outline• Overview of new CPT codes for 2018
• TCAR
• Venous Closure– Venaseal– Varithena
• Apthus
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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
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TRANSCAROTID ARTERY REVASCULARIZATION
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• 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.
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Varithena for Venous Ablation
Polidocanol 1% foam using 65:35 O2:CO2
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Varithena for Venous Ablation
• US guided
• No tumescence
• Single mid leg access
• Do not need straight vein!
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Issues
• Foam floats!
• Single access in mid-leg
• US guided, no catheter
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Venaseal for Venous Ablation
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Venaseal for Venous Ablation
• US guided
• No tumescence
• No nerve issues
• Catheter-based delivery system
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Venaseal
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Venaseal
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Conclusions• TCAR is reviving carotid stenting
• New venous ablation techniques have advantages for certain clinical situations
• New codes, but not really any new reimbursement
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