CPT CODE 71260, 71270 and 71275

PEDIATRIC AND CONGENITAL PVD GUIDELINES

GENERAL GUIDELINES

** The Peripheral Vascular Disease Imaging Guidelines are the same for both the pediatric population and the adult population, unless there are specific guidelines   listed here in the Pediatric and Congenital Peripheral Vascular Disease Imaging  Guidelines.



AORTIC DISORDERS, RENAL VASCULAR  DISORDERS, and VISCERAL ARTERY ANEURYSMS 

** Thoracic Aortic Disease

o Chest CT (CPT®71260 or CPT®71270), chest CTA (CPT®71275), or chest MRA (CPT®71555) can be used for surveillance or follow-up of thoracic aortic abnormalities in patients with Loeys-Deitz syndrome, Marfan’s syndrome, Takayasu’s arteritis , or Kawasaki syndrome.*


o Less lethal disorders such as Turner syndrome and tuberous sclerosis have also been associated with aortic dissection.*


** Aortic Congenital Vascular Malformations

o Aortic congenital vascular malformations can be seen with chromosomal abnormalities such as Turner syndrome

o Malformations can include aortic coarctation and aortic valve abnormalities.

o Cardiac MRI (CPT®75557 or CPT®75561), chest MRA (CPT®71555), chest CT (CPT®71260), or chest CTA (CPT®71275) may be needed for evaluation.

o Specialist input is helpful in determining the appropriate imaging pathway.

o Coarctation is usually detected at younger ages with blood pressure substantially elevated in one or both upper extremities relative to lower extremity blood pressures. Plain chest x-ray in this syndrome may also  demonstrate characteristic “rib notching.”


** Visceral Artery Aneurysms

o These include arteries to the spleen, kidney, liver and intestines

o Aneurysm of these arteries is defined by an increase of more than 50% of the original arterial diameter

o Risk for rupture is high when the aneurysm is greater than 2 cm or is increasing rapidly*

o Vascular specialist consultation is beneficial in order to determine the timeframe to intervention.

o Monitoring by ultrasound or CT with contrast is appropriate, although ultrasound should be attempted first

o Celiac artery aneurysm can be evaluated by CT abdomen with contrast (CPT®74160), CTA abdomen (CPT®74175), or ultrasound (CPT®76700 or CPT®76705).*


o No definitive time period for serial studies has been established.

** Initial evaluation with six month follow-up is reasonable.

** Yearly follow-up in conjunction with vascular specialist consultation should be performed if no significant enlargement is seen.

** Follow-up imaging after stent placement

o No definitive guidelines have been established for follow-up imaging, but it would be reasonable to follow the same time table as for endovascular aortic repair: CTA of abdomen (CPT®74175), MRA of abdomen (CPT®74185), or CT abdomen (CPT®74160) at 1 month, 6 months, and 12 months following stent placement, then every year. An additional study can be done at 3 months if there was evidence of endoleak on the 1 month study.