Cardiology Coding Alert

Reporting endovascular repair of the abdominal aorta or iliac arteries can be a real challenge because you have so many different codes to choose from. Along with all of these codes, you also must follow specific CPT^® guidelines. And, if you don’t read your cardiologist’s medical the documentation carefully, you could lose out on deserved revenue.

Take a look at what you need to know when your cardiologist uses an endograft to treat an abdominal aortic pathology in the infrarenal abdominal aorta.

Use 34701-34706 for Endografts in Infrarenal Abdominal Aorta

You will turn to codes 34701-34706 when your cardiologist uses an endograft to treat an abdominal aortic pathology in the infrarenal abdominal aorta. Note: These procedures could include the iliac arteries.

For example, look at one of the code pairs in the 34701-34706 code set:

• 34701 (Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer))
• 34702 (…for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption))

When you look in the medical documentation for these procedures, you may see different terms that point to a “covered stent.” These include an endovascular graft, endoprosthesis, endograft, and stent graft.

The CPT^® guidelines also specifically define an infrarenal aortic endograft. “The infrarenal aortic endograft may be an aortic tube device, a bifurcated unibody device, a modular bifurcated docking system with docking limb(s), or an aorto-uni-iliac device.”

Carefully Follow CPT^® Guidelines for 34701-34706

The CPT^® guidelines for 34701-34706 are very specific about how you should report these codes.

Codes 34701-34706 include the introduction, positioning and deployment of an endograft used to treat an abdominal aortic pathology, according to the CPT^® guidelines. Listed abdominal aortic pathologies include pseudoaneurysms, dissection, penetrating ulcers, or traumatic disruption in the infrarenal abdominal aorta. These pathologies could either include extension into the iliac artery(ies) or not.

This code set includes codes both with and without rupture. For example, if you look at the above code descriptors for 34701 and 34702, you will see that you should report 34701 “for other than rupture,” and you should report 34702 “for rupture.”

“Ruptures are defined as clinical and/or radiographic evidence of acute hemorrhage,” according to Sharon Jane Oliver, CPC, CDEO, CPMA, CRC at the 2020 Virtual HEALTHCON session “Peripheral Vascular Coding/Compliance.” You should report codes 34702, 34704, 34706, and endovascular repair of iliac artery repair by deployment of an ilio-iliac tube endograft code 34708 (Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s)…) for ruptures.

Additionally, a chronic contained rupture is a considered a pseudoaneurysm, Oliver says. For this condition, you should report codes 34701, 34703, 34705, and endovascular repair of iliac artery repair by deployment of an ilio-iliac tube endograft code 34707.

Identify Specific Treatment Zones

The CPT^® guidelines clearly identify the treatment zones for these endovascular procedures, according to Oliver.

“The treatment zone for endograft procedures is defined by those vessels that contain an endograft(s) (main body, docking limb[s], and/or extension[s]) deployed during that operative session,” per the CPT® guidelines.

The abdominal aortic treatment zones you should look for are as follows:

• Infrarenal aorta — codes 34701 and 34702
• Infrarenal aorta and ipsilateral common iliac artery — codes 34703 and 34704
• Infrarenal aorta and both common iliac arteries — codes 34705 and 34706

The guidelines are a major help when you are coding these procedures, Oliver says. So, take your time and read them carefully.

Oliver also recommends querying your cardiologist if you ever have a question about these endovascular procedures.

“Don’t hesitate to go to your physician and query them,” Oliver says. “I have never met a physician who was not willing to teach.”

Oliver does add that if you do query your physician, you should always have your CPT^® manual with you. “Walk in with your CPT^® manual, turn to where you are coding at, and let them see what you need to know to be able to fully give them credit for the work that they did.”

Don’t Forget Rules for Add-on Codes +34717 and +34713

Code +34717: If you report codes 34703-34706, you may also find yourself needing to report add-on code +34717 (Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s)…), as well.

You should report +34717 at the time of the aorto-iliac artery endograft placement (codes 34703-34706) “for deployment of a bifurcated endograft in the common iliac artery with extension(s) into both the internal iliac and external iliac arteries, when performed, to maintain perfusion in both vessels for treatment of iliac artery pathology (with or without rupture) …,” according to the CPT^® guidelines.

The guidelines define an iliac branched endograft as “a multi-piece system consisting of a bifurcated device that is placed in the common iliac artery and then additional extension(s) are placed into both the internal iliac artery and external iliac/common femoral arteries as needed, as well as a proximal extension that overlaps with an aorto-iliac endograft, when performed.” Also remember that “all additional extensions proximally into the common iliac artery or distally into the external iliac and/ or common femoral arteries are inherent to these codes.”

You should only report +34717 once per side, per the CPT^® guidelines. For a bilateral procedure, you should report 34717 twice. You should never append modifier 50 to 34717.

Code +34713: You can also report add-on code +34713 (Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral…) in conjunction with codes 34701-34708, according to Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. You should only report +34713 once per side, per the CPT^® guidelines. For a bilateral procedure, you should report +34713 twice.

“You should never append modifier 50 (Bilateral procedure) in conjunction with +34713,” Neighbors adds. “Do not report +34713 for percutaneous closure of femoral artery after delivery of end-vascular prosthesis if a sheet smaller than 12 French was used.”

Editor’s note: Want more great info like this? You can now register for the upcoming 2020 HCON regional conferences: https://www.aapc.com/medical-coding-education/conferences/. Also, early bird registration is open for 2021 HCON in Dallas. Visit www.aapc.com for more info.