Cardiology Coding Alert

CPT 2001 has introduced several new codes, many of which are separately billable, to describe endovascular repair of abdominal aortic aneurysms (AAA) procedures that formerly had to be billed using a single unlisted procedure code (37799, unlisted procedure, vascular surgery). In addition, two new radiology codes may also be billed with the procedures under certain circumstances.

Endovascular repair involves the introduction of a collapsed prosthesis through arteries in the groin (either femoral or iliac). The prosthesis is advanced into position under fluoroscopic guidance, after which a balloon inflates it to full size and metal clips on the distal and proximal ends of the device latch on to the inside of the artery. According to Diane Elvidge, CPC, senior reimbursement specialist with Princeton Reimbursement Group in Minneapolis, cardiologists are increasingly performing these procedures.

Applying the New Codes

The first three codes in the endovascular AAA repair subsection describe variants of the same procedure. Code 34800 (endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis) describes placement of an endovascular tube graft in the aorta from a single groin incision. Because the anatomy of most patients is not suitable for this type of graft, it is not placed frequently.

More often, the aneurysm will extend to the very distal aorta or into the proximal common iliac arteries. Because no adequate normal distal portion of aorta is available to accept a tube prosthesis, the physician will instead place a bifurcated graft. Two codes describe such a graft. Code 34802 (endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [one docking limb]), the most frequently performed of these three procedures, uses a modular design in which the main aortic prosthesis is attached to two short docking limbs in both iliac arteries. The other bifurcated graft, 34804 (endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using unibody bifurcated prosthesis), describes the placement of a one-piece prosthesis specifically designed to the dimensions of the patient.

In addition to the endovascular repair, the physician may perform one or more other procedures to complete the treatment. For instance, an occlusion device may be placed (34808, endovascular placement of iliac artery occlusion device [list separately in addition to code for primary procedure]) to block off a stenosed or otherwise diseased iliac artery that cannot be treated with an endosvascular graft. This procedure, in turn, requires a vascular surgeon to place a femoral-femoral prosthetic bypass graft (34813, placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair [list separately in addition to code for primary procedure]) to maintain the patients blood flow to the affected leg.

Note: Codes 34808 and 34813 are add-on codes and may not be [...]