General Surgery Coding Alert

Report prosthesis insertion by site of introduction When picking your way through an endovascular abdominal aortic aneurysm (AAA) repair op note, you-ll want to look closely for several separately reportable services, including radiologic supervision and interpretation (S&I), artery exposure for prosthesis placement, and others. Make sure you have the information you need to identify and report all components of an AAA repair and garner the full payment you deserve. Include Angioplasty Within Treatment Zone You should not separately report balloon angioplasty or stent deployment within the target treatment zone along with primary AAA endovascular repair codes 34800-34805, according to CPT guidelines. The surgeon uses angioplasty to inflate, and a stent to help maneuver, the prosthesis after placing it. The AMA has designed 34800-34805 to include these services.

But CPT guidelines confirm that when the surgeon must perform angioplasty or deploy a stent in a separate area, you may report the angioplasty and/or stent as separate from the AAA repair. You will have to append modifier 59 (Distinct procedural service) to the angioplasty or stent code to show the payer that the procedure is not a part of the primary service, and the surgeon's documentation will have to substantiate that the angioplasty and/or stent occurred at an area distinct and separate from the AAA repair.

Have all the information at your fingertips: For complete information on how to report primary AAA repair/prosthesis, as well as endovascular to open conversion repairs and placement of extension cuffs, look to -Technology Review Allows You to Report Endovascular AAA Repairs With Ease,- General Surgery Coding Alert, No. 9, Vol. 9, pp. 61-64.

Get the Prosthesis Into the Vein In some cases, the surgeon must expose either the femoral or iliac artery to facilitate introducing the sheath required for the endovascular AAA repair, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock. The primary repair codes do not include this service, and therefore you should report it separately.

For femoral artery exposure, report 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral). For insertion into an iliac artery, call instead on 34820 (Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral).

Bilateral procedure calls for bilateral modifier: Codes 34812 and 34820 are unilateral, as specified by AMA/CPT and CMS/Correct Coding Initiative (CCI) guidelines. Therefore, if the surgeon must access arteries bilaterally (that is, one in each leg), be sure to append modifier 50 (Bilateral procedure) to the appropriate exposure code. Because of the additional work, Medicare carriers customarily pay such claims at 150 percent of the unilateral rate.

Example: If the surgeon uses [...]