open sma thrombectomy cpt code

Primary perc. %PDF-1.4 % hb```f``S @Q&x6-@R$"U58IdaA|!@Y0(%joUX ld" c,%v'{N0lee2b+<>< x!dgFO'|kN$c8!9/@A~ .h @ di91 EL'iy .o2VbH"iDfk]}Pe?}^PF|0t/Z v=;i|0A'$!xsi?B+qy qRx K>pGaq^CV-V"ifTD('6UwBX8O+[wqkkO)DDV*:9$R A'] lz+'"e+vsNS).kX@. Created with Sketch. 5 0 obj You should report 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel) for endovascular mechanical thrombectomy in the initial arterial vessel, per CPT Assistant. You should report 37184 (Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel) for endovascular mechanical thrombectomy in the initial arterial vessel, per CPT Assistant. right-arrow However, the frequency of thrombectomy is highly variable and ultimately depends on the location and extent of the blood clot. <> Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. For Medicare, physician reimbursement is under the RBRVS system. Underdosing of thrombolytic drugs. You have separate code sets for both arterial (37184-+37186) and venous transcatheter therapies (37187 and 37188). 1048 0 obj <> endobj 1Y\v%XI-uq\mV;dMx,(2Y$Fs%_g?-dxdQQBo6-6l6\+JrPExpvnGOiTMNqUse$C(nSB_2/ !'o'IO@\3 61645 for the treatment of the same vascular territory The fistula is actually the third such loop fistula placed in the concentric fashion with this being the outermost of the three fistulas. The procedure performed is a Thrombectomy, which is listed in the CPT manual index. This code includes the open access to the brachial artery, all of the roadmapping and fluoroscopic guidance, stent placement, post-deployment angioplasty and completion angiography. 16 0 obj (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613201/), (https://missionthrombectomy2020.org/know-the-facts/), Visitation, mask requirements and COVID-19 information, Heart, Vascular & Thoracic Institute (Miller Family). Note: You should never report 37184 in conjunction with intracranial arterial transluminal mechanical thrombectomy code 61645, fluoroscopy code 76000, or injection code 96374, according to the CPT guidelines. Open Approach ICD-10 Procedure Code15 Description Inpatient Hospital Billing Codes Medicare inpatient hospital reimbursement is based upon the Medicare Severity Diagnostic-Related Group (MS . The code specifies "vein (s)" which means any number of veins treated is reported as 37187. You should call your healthcare provider if you experience the following after your procedure: A thrombectomy is a surgery to remove a blood clot from an artery or vein. stream 1072 0 obj <>/Filter/FlateDecode/ID[<5343C858D6BA874797169103B3ECDC80><423DA04E8331BC42A6D944E079F6CEF6>]/Index[1048 38]/Info 1047 0 R/Length 114/Prev 494124/Root 1049 0 R/Size 1086/Type/XRef/W[1 3 1]>>stream Embolectomy/Thrombectomy Procedures on Arteries and Veins. Additionally, you should never report +37185 in conjunction with 61645 for the treatment of the same vascular territory. KarenZupko & Associates, Inc. 2023 | All Rights Reserved, Use of Tissue Adhesive for Laceration Repair. <> Mechanical thrombectomy involves the removal of a thrombus (blood clot) from a vessel (eg, thrombotic occlusion of an extremity artery) to help restore circulation, according to CPT Assistant Vol. Dont miss: Your cardiologist will always perform a secondary arterial mechanical thrombectomy in conjunction with another primary intervention such as a transluminal balloon angioplasty or a stent placement, and you will report those procedures separately. Code 75746 is bundled into 37184, so you should report 75746 only if its for a truly diagnostic angiogram (no previous ones available, the decision to perform the thrombectomy was based on this angiography, etc.). There was no evidence of stenosis in the vein in the antecubital fossa with the median cubital vein remaining widely patent as it has always been with no evidence of venous outflow stenosis in the vein. Percutaneous (minimally invasive) thrombectomy Reporting myocardial infarctions in [], Expert Advice Helps You Target Appropriate Modifier 24, 25, and 57 Use, Remember: Modifier 25 applies to E/Ms with minor procedure. The patient had thrombus in the loop Gore-Tex fistula in the right forearm. endobj more than one month after original operation (list separately in addition to code for primary procedure). Note: You should never report +37185 in conjunction with 76000 or injection code +96375, according to CPT. The arteriograms were read as above. Centers for Disease Control and Prevention. For the IVC filter placement, you should report 37191 (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance [ultrasound and fluoroscopy], when performed). Thrombectomy codes include getting rid of clot by any method, including balloon maceration.. And, you should report +37185 ( second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)) for the second or all subsequent vessels within the same vascular family. Physicians use ICD-10 CM codes for diagnoses and CPT codes for procedures, regardless of whether the setting is inpatient or outpatient. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. other interventions (eg percutaneous transluminal angioplasty) may be performed in conjunction with the thrombectomy to treat a previously unidentified (revealed only after clearing the thrombus) underlying pathology (eg, stenosis), and may be separately reported. When your cardiologist performs a mechanical thrombectomy, you should check the medical documentation for specific details such as whether it is an arterial or a venous procedure. To report an open radical nephrectomy, use CPT code 50230 Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy. 12 0 obj mechanical thrombectomy, noncoronary, initial vessel: 37184. The underlying arterial and venous limbs of the graft were dissected free from surrounding structures and the patient was given 5,000 units of Heparin IV. <> As stated under Operative Findings, the patient had thrombus in the loop Gore-Tex fistula in the right forearm. x . 3 0 obj You must also know if the arterial mechanical thrombectomy is primary or secondary. There was a widely patent graft and good venous outflow into the cephalic vein in the arm. In those . 9. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 21 0 R/Group<>/Tabs/S/StructParents 2>> Angiojet . open, flexor; toe, single (separate procedure . A review of the entries under this term reveals that your choice will be Dialysis Graft without Revision 36831. CPT: Handy Tips Guide Your Arterial and Venous Mechanical Thrombectomy Claims, Handy Tips Guide Your Arterial and Venous Mechanical Thrombectomy Claims, Mechanical thrombectomy involves the removal of a thrombus (blood clot) from a vessel (eg, thrombotic occlusion of an extremity artery) to help restore circulation, according to, If your cardiologist performs a secondary transcatheter procedure, you should report +37186 (, A secondary transcatheter thrombectomy procedure is performed for the removal or retrieval of segment(s) of a thrombus or embolus, typically after another percutaneous intervention that was complicated by a thrombotic event, according to. American Hospital Association ("AHA"). If mechanical thrombectomy is also required, this is separately reported. Predicting Death After Thrombectomy in the Treatment of Acute Stroke. [ 17 0 R] The fistula is actually the third such loop fistula placed in the concentric fashion with this being the outermost of the three fistulas, and the only one currently functioning with the other two being disconnected. Thrombectomy is a common or procedure. -i.e. Caution: You should never report +37186 in conjunction with the following codes: *This response is based on the best information available as of 03/03/16. )N7gg{~[G7h2i?$)f!fk">A hb``e``Ab@1`3l~:~v'Qb` *e, *d r]$.?W - The procedure codes listed below are applicable to Venous/Arterial Mechanical Thrombectomy (PMT) cases. This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33763 Vascular Stenting of Lower Extremity Arteries provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. Alternatively, when arterial pathology is known prior to an endovascular intervention and pre-procedure planning is focused on correction of the pathology (eg angioplasty or stenting), secondary thrombectomy may be performed to remove short segments of thrombus also known to be present to prevent complications (distal clot embolization) or to enhance the correction of the pathology.. -Per CPT Assistant - "Code 35875 describes the thrombectomy of arterial or venous bypass placed . Note: You should never report 37184 in conjunction with intracranial arterial transluminal mechanical thrombectomy code 61645, fluoroscopy code 76000, or injection code 96374, according to the CPT guidelines. However, services performed for any given diagnosis . Emails full of tips, news, resources and advice will be sent your way soon. endobj <>>> Operative Technique: After induction of a right axillary block without complications, the right upper extremity was prepped with duraprep solution and draped using sterile towels and sheets. After he performs the thrombectomy, he will conduct a post-procedure evaluation. A#j]i7,"JyZNOglbTP-8gBQxS#f*~`JLH*EW|\,^J?^>Jh"*BHNd$I~wo2UIH^QKd`_V|P&J\#n>5o3Z>+|RsO KZakLr:L0e\j "Mechanical thrombectomy involves the removal of a thrombus (blood clot) from a vessel (eg, thrombotic occlusion of an extremity artery) to help restore circulation," according to CPT Assistant Vol. A thrombectomy is a surgery to remove a blood clot from a blood vessel (artery or vein). snare basket, suction technique), add-on to primary procedure +37186. Tip 5: Put it All Together With an Example. Jean Kayser CPC CIRCC endstream The code specifies vein(s) which means any number of veins treated is reported as 37187. <> Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. 13 0 obj However, you can separately report catheter placement, diagnostic studies, and other percutaneous interventions such as a transluminal balloon angioplasty and stent placement. <> 2014 CPT Changes . 996.73 Other complication due to renal dialysis device, implant and graft, Under the heading Operative Technique, the surgeon states that an incision was made in both limbs of the graft and that the clot was removed using Fogarty catheters until brisk flow was returned in both ends of the graft. 9. 14 0 obj endstream The fistulogram showed adequate arterial end flow with good arterial vessels coming from the brachial artery and through its bifurcation into the forearm. However, for determining Medicare payment, only the CPT procedure codes are used. 33233: Cardiovascular: Removal of permanent pacemaker pulse generator. Last reviewed by a Cleveland Clinic medical professional on 05/02/2022. The procedure may help you if the clot blocks blood flow to a part of your body, putting you at risk for: You might not be a candidate for a thrombectomy if you have: Not all blood clots require intervention. endobj 19 0 obj Thrombectomy codes include getting rid of clot by any method, including balloon maceration. %%EOF The ICD-10 CM diagnosis codes are used for claims adjudication. A blood clot in a location thats too hard to reach. The procedure can restore blood flow to vital organs, such as your legs, arms, intestines, kidneys or brain, and reduce the risk of death or permanent tissue damage. 18 0 obj Since this code includes intraprocedural thrombolytic injections, you cannot report the TPA injections separately. <> 3 0 obj Providers should select the most appropriate code(s) and modifier(s] with the highest level of detail to . American Hospital Association ("AHA"), Arterial Embolectomy/Thrombectomy Procedures, With or Without Catheter, Venous Embolectomy/Thrombectomy, Direct or With Catheter, Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare. Catheter-directed mechanical thrombectomy with or without thrombolysis. Sp4#Y_]:B"4"1mOD|vG=`^,#lV4*~P^f:}^Nf;tN E}MA .ZDp3/`/1bpDR#8?\E1["2*Jd_P o, 're. Your cardiologist will always perform a secondary arterial mechanical thrombectomy in conjunction with another primary intervention such as a transluminal balloon angioplasty or a stent placement, and you will report those procedures separately. 0000011433 00000 n 2 0 obj The cardiologist performed an angiojet thrombectomy with multiple passes in the main pulmonary artery and an IVC venogram to identify the renal veins, as well as an IVC filter placement. Note: You should never report +37185 in conjunction with 76000 or injection code +96375, according to CPT. A review of the entries under this term reveals that your choice will be Dialysis Graft without Revision 36831. During a mechanical thrombectomy, your surgeon introduces special devices through catheters that can either macerate or suction out clots from within your blood vessel. We do not endorse non-Cleveland Clinic products or services. <> If your cardiologist performs a secondary transcatheter procedure, you should report +37186 (Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in conjunction with another percutaneous intervention other than primary mechanical thrombectomy (List separately in addition to code for primary procedure)). Caution: If you are reporting mechanical thrombectomy of an additional vascular family the cardiologist treated through a separate access site, you should append modifier 59 (Distinct procedural service) to 37184 for the mechanical transluminal thrombectomy. Access to Mechanical Thrombectomy for Ischemic Stroke in the United States. 9. <> endstream endobj startxref Dont miss: Codes 37184-37188 include the intraprocedural fluoroscopic radiological supervision and interpretation services for the thrombectomy guidance, according to the CPT guidelines. 2023 Bryn Mawr Communications II, LLC. By Katharine L. Krol, MD, FSIR, FACR, RCCIR. Adjunctive angioplasty of the atherectomized lesion was performed in 55 % of cases, stenting in 0 %, and adjunctive therapy for tandem lesions in 39 %. If your cardiologist uses venous transcatheter therapies, you should report code 37187 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance) for the initial application. The incisions were then closed. x=]o9qf7 f'fAd[Y^y*f>b}Xl~[Cw2^~_Yon|j\UoD_F| +(W?ej%|?(/_0DV"xN|n8,D~eE~RD _g_|W/D6yYi9r.#znz{-r->rQJ} <> OBL, ASC, or Hybrid: Which Model Is Right for You? Get fresh tips and insights emailed to you, This content was produced in its entirety for ADVANCE Healthcare Network (1985-2019, now Elite Healthcare) and features original contributions from a qualified and experienced editorial team or was provided to ADVANCE by credible industry experts or qualified healthcare professional(s). Anticoagulants are drugs that thin your blood to prevent more blood clots from forming and allow your body time to try to dissolve non-emergency clots over time. endobj 10 0 obj When your cardiologist performs a primary arterial mechanical thrombectomy, he will diagnose the thrombus prior to performing the mechanical thrombectomy procedure. +96375 They include both open and percutaneous endovascular approaches. endobj Previous Article, Renal Artery Stenting With Embolic Protection. "WU*{wWc/NN?cnfFoFoFoFoF_qMY02TCi0t&1.>iqsw.Kw` ''6m endstream endobj 53 0 obj <> endobj 54 0 obj <> endobj 55 0 obj <> endobj 56 0 obj <> endobj 57 0 obj <>stream Hint: If your cardiologist uses venous transcatheter therapies, you should report 37187. 0000002891 00000 n A graftotomy was made transversely in the distal venous limb of the graft and in the first centimeter of the arterial end of the graft and thrombectomy accomplished with 3 and 4 Fogarty catheters with brisk arterial end flow and good venous back-bleeding noted. 0000001117 00000 n stream All Rights Reserved Privacy Policy, Katharine L. Krol, MD; Sean M. Tutton, MD; Dawn Hopkins. The COVID19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. hea Dont assume the codes youve been using to report drugs and biologicals still apply. mLp4'b+8r~%uHcb?? <> A blood clot, also known as a thrombus, can interrupt the blood flow to your extremities and/or organs that can be limb or life-threatening. He also administered a TPA injection. BEST-CLI Shows Lower Incidence of Major Adverse Limb Events or Death With Surgical Bypass Versus Endovascular Treatment in CLTI Patients With Adequate GSV, With Alik Farber, MD, MBA; Matthew Menard, MD; and Kenneth Rosenfield, MD, MHCDS, Current Evidence for Catheter-Based Renal Denervation for Hypertension, By Anna K. Krawisz, MD, and Eric A. Secemsky, MD, MSc, RPVI, FACC, FAHA, FSCAI, FSVM, Panel Discussion: Perspectives on Applying BEST-CLI in Practice, With Daniel Clair, MD; Sanjay Misra, MD; Leigh Ann O'Banion, MD; and Mehdi H. Shishehbor, DO, MPH, PhD, By Anahita Dua, MD, MBA, MSc, and Eric A. Secemsky, MD, MSc, RPVI, FACC, FAHA, FSCAI, FSVM, Tackling Acute-to-Chronic Thrombus and Embolus. Tip 2: Follow Rules for Primary Arterial Mechanical Thrombectomy Catheter-directed aspiration thrombectomy. Dont miss: Codes 37184-37188 include the intraprocedural fluoroscopic radiological supervision and interpretation services for the thrombectomy guidance, according to the CPT guidelines. You may see angioplasty performed to macerate clot, says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. 0000003795 00000 n `MY312`4S7f{3L&:-*@LDP.q+6g`wd@-B4p0wT@Um0 >\ 5"F_jELo5yxKW:)(Ki^%T~!=!T g=>,6SFW_,bv y6[' tU1DcR,Id.-P8ih&@dF_?{vbhpV{U[3UF !&8`ZC;{YyM3Ly In the right upper extremity, there is a looped Gore-Tex subcutaneous graft in the right forearm with no palpable pulse, thrill or audible bruit. The correct code for the radiological portion of the main pulmonary artery angiography is 75746-26 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation; Professional component). Advertising on our site helps support our mission. 0000002216 00000 n However, you can separately report catheter placement, diagnostic studies, and other percutaneous interventions such as a transluminal balloon angioplasty and stent placement. Caution: If you are reporting mechanical thrombectomy of an additional vascular family the cardiologist treated through a separate access site, you should append modifier 59 (Distinct procedural service) to 37184 for the mechanical transluminal thrombectomy. <> Poisoning by thrombolytic drug, undetermined. Effective in 2017, three codes (36901, 36902, 36903) were created to . % 1-ranked heart program in the United States. trailer <<16A9AA9C32FA437D841E9118AE6FC6CE>]/Prev 111815>> startxref 0 %%EOF 70 0 obj <>stream endstream endobj 1049 0 obj <. To report a true diagnostic angiogram, append modifier 59 (Distinct procedural service) to 75746. Tip 3: Delve Into Secondary Arterial Mechanical Thrombectomy. Coding solution: For the thrombectomy, you should report 37184. Read on to keep your mechanical thrombectomy procedures in tip-top shape. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. On the other hand, if your cardiologist performs repeat treatment on a subsequent day during the course of thrombolytic therapy, you should report 37188 (Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy). endobj A secondary transcatheter thrombectomy procedure is performed for the removal or retrieval of segment(s) of a thrombus or embolus, typically after another percutaneous intervention that was complicated by a thrombotic event, according to CPT Assistant. If a percutaneous thrombectomy is performed in more than one vein, can each one be reported separately? 0000013907 00000 n 17 0 obj 512 0 obj <>stream 0000005368 00000 n Additionally, you should never report +37185 in conjunction with 61645 for the treatment of the same vascular territory. Next Article ICD-10-CM Diagnosis Code T45.615. Talk to your provider about other ways to reduce the risk of blood clots. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156540/). Coding example: In the hospital, the cardiologist performed a diagnostic angiography on the main pulmonary artery. The correct code for the radiological portion of the main pulmonary artery angiography is 75746-26 (Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation; Professional component). A total of 39 % of patients had prior IF interventions. _R#r{)"3 `*c 0000006871 00000 n Embolus (when a thrombus breaks loose from one location and travels to another location in your body). Get useful, helpful and relevant health + wellness information. A 4 cm transverse incision was made with an existing transverse scar in the antecubital fossa. 4 0 obj ICD-10-CM Diagnosis Code T45.616S [convert to ICD-9-CM] Underdosing of thrombolytic drugs, sequela. CPT . Extremities: Symmetrical without edema. 0000012925 00000 n 0000020936 00000 n endobj hbbd```b``3>d"'E D 9.H EuIFOx14lc"-fwH0{ Aag3$#R d`bd` e @ Y 443 0 obj <> endobj 0000015834 00000 n Arterial Thrombectomy . Dont miss: Your cardiologist will always perform a secondary arterial mechanical thrombectomy in conjunction with another primary intervention such as a transluminal balloon angioplasty or a stent placement, and you will report those procedures separately. 29, No. The procedure performed is a Thrombectomy, which is listed in the CPT manual index. Code 75746 is bundled into 37184, so you should report 75746 only if its for a truly diagnostic angiogram (no previous ones available, the decision to perform the thrombectomy was based on this angiography, etc.). 2014 New AAA Coding Codes 34842-34848 should NOT be used for chimneys, snorkels or periscopes. Adverse effect of thrombolytic drugs. Since this code includes intraprocedural thrombolytic injections, you cannot report the TPA injections separately. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> xTMo0Q*VE%vEt ;;HIe~d>qCD>Qt5+]wIBJ`H&0zq7} j7g "ms`l&l)X A secondary transcatheter thrombectomy procedure is performed for the removal or retrieval of segment(s) of a thrombus or embolus, typically after another percutaneous intervention that was complicated by a thrombotic event, according to CPT Assistant. Most people take blood-thinning medication to prevent another clot from forming. The average lesion treatment length was 9.2 +/- 6.0 cm (range of 2 to 20), with a run-off score of 5.4 +/- 2.4. endobj 20 0 obj Alternatively, when arterial pathology is known prior to an endovascular intervention and pre-procedure planning is focused on correction of the pathology (eg angioplasty or stenting), secondary thrombectomy may be performed to remove short segments of thrombus also known to be present to prevent complications (distal clot embolization) or to enhance the correction of the pathology. The cardiologist will also preoperatively plan the thrombectomy. 0000000756 00000 n endobj <> Hint: If your cardiologist uses venous transcatheter therapies, you should report 37187. Society of Vascular and Interventional Neurology (SVIN). endobj Answer: Coding example: In the hospital, the cardiologist performed a diagnostic angiography on the main pulmonary artery. Insertion of IVC filter, includes vessel access, selectionand imaging . And, you should report +37185 ( second and all subsequent vessel(s) within the same vascular family (List separately in addition to code for primary mechanical thrombectomy procedure)) for the second or all subsequent vessels within the same vascular family. {& $atey( lS+ m. 7 0 obj 0000014329 00000 n Everything we have learned about AV dialysis circuit interventions so far tells us that the open thrombectomy should be coded with CPT 36831 and the percutaneous balloon angioplasty should be coded with 36902, but again, the CPT guidelines say you may not report these two codes together. 48 0 obj <> endobj xref 48 23 0000000016 00000 n After he performs the thrombectomy, he will conduct a post-procedure evaluation.