ED Coding and Reimbursement Alert

Question: I have been coding in an ED for a few months and have not had experience in coding aneurysms yet. How would the ED physician treat a patient's aneurysm, and what are the different types of aneurysms we might see in the ED?

Connecticut Subscriber

Answer: When a blood vessel wall weakens, it can result in an abnormal ballooning or widening, called an aneurysm. The condition can be congenital or related to hypertension, although sometimes the cause is not known.

Although often asymptomatic, patients might present with symptoms such as localized swelling, pain, or throbbing near an aneurysm of the extremities, or localized pressure on associated structures that causes numbness. If an aneurysm ruptures, it can lead to massive bleeding and even death, making these patients very serious ED presentations.

The ED physician might diagnose aneurysm using ultrasound and computed tomography (CT) scan evaluation. Common treatments, though not typically performed by the emergency physician, include surgery (35082) or placement of a stent. An endovascular stent graft involves inserting a metal mesh tube into the vessel at the location of the weakness, such as 34802 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [one docking limb]).

Common aneurysms that the ED physician might
treat include:

Aortic -- The aorta is the major artery from the heart, and aneurysms are common in two sections of the vessel. The condition may be asymptomatic until rupture, leading to abdominal rigidity and shock. The physician might also treat a related condition -- aortic dissection.

You-ll need to know the location and condition of the aneurysm or dissection to assign the proper ICD-9-CM codes as follows:

- Abdominal aortic aneurysm (AAA) -- Occurring in the abdominal regions, use 441.3 or 441.4 to report the condition with or without rupture.

- Thoracic aortic aneurysm (TAA) -- Occurring in the thoracic region, report TAA as 441.1 or 441.2 depending on the presence of a rupture. For an aneurysm involving both regions, report 441.6 or 441.7 depending on rupture status. For unspecified site, use 441.5 or 441.9

- Aortic dissection -- A dissection occurs when blood enters through a tear in the lining of the aorta into the space between the middle and outer layers of the vessel causing a separation. This can occur in the abdominal or thoracic aorta, and you-ll assign the proper code 441.0x based on the site.

- Other -- Use code 442 to report other common aneurysm sites, including renal artery (442.1), femoral or popliteal arteries (442.3), carotid artery (442.81), or unspecified (442.9). Other codes include pulmonary artery (417.1) and coronary vessels (414.11).