Anesthesia Coding Alert

CPT codes for endovascular repair of abdominal aortic aneurysm (AAA) were a welcome addition in 2001. But two years later, coders are still often confused about which anesthesia code best represents the procedure. One Procedure Presents Many Anesthesia Options AAA endovascular repair is an alternative to more invasive treatments of the problem. It involves placing a stent graft within the lumen of the aorta and usually the iliac(s). The surgeon uses fluoroscopic guidance to thread the graft through the femoral artery to the surgical site. The procedure is performed under epidural or general anesthesia or monitored anesthesia care (MAC), depending on the situation.


"Many of these cases are done under epidural anesthesia," says Mary Klein, CPC, an anesthesia coding specialist with Panhandle Medical Services in Pensacola, Fla. "The patient's overall state of health (comorbidities) sometimes might dictate using general anesthesia. Sedation may also be used in conjunction with the epidural to increase the patient's comfort.


" Whichever type of anesthesia the provider uses, codes remain the same except in states that require you to add MAC modifiers when appropriate (-QS, Monitored anesthesia care service; -G8, Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure; and -G9, Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition). You don't report the MAC modifier, however, if the epidural is the mode of anesthesia and the provider uses sedation to increase the patient's comfort, Klein says. Evaluate the Coding Options The primary surgical code for AAAendovascular repair is CPT 34800 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis). This describes placement of a single tube, but many surgeons use a bifurcated, or split, tube that extends two limbs into the iliac arteries to ensure more complete coverage of the aneurysm. You should report this type of prosthesis with 34802 ( using modular bifurcated prosthesis [one docking limb]) or 34804 ( using unibody bifurcated prosthesis).

The primary cross-code for anesthesia during the procedure is 00770 (Anesthesia for all procedures on major abdominal blood vessels), but coders have differing opinions about its appropriateness. More confusion arises because of alternative cross-codes or varying combinations of primary and secondary cross-codes in different resources.                                  

For example, older editions of the ASACrosswalk list 01933 (Anesthesia for therapeutic interventional radiologic procedures involving the venous/lymphatic system [not to include access to the central circulation]; intracranial) as the primary cross-code for 34800, then 00770. Klein disagrees with using 01933 for the procedure, stating that surgical code 34800 and related codes 34802 and 34804 now all correspond to anesthesia code 01926 (Anesthesia for therapeutic interventional radiologic procedures involving the arterial system; intracranial, intracardiac, or aortic). "Code 01933 also specifies only the intracranial venous [...]