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General Surgery Coding Alert

Cardiovascular System:

New AAA Repair Codes Top the List of Vascular Changes

Published on Thu Oct 28, 2004

You'll also have a choice of 4 ablation therapy and 2 transcather codes in 2005

You'll have to begin reading operative reports for endovascular repair of abdominal aortic aneurysms a bit more closely from now on, because CPT adds a new code to describe a variation on these procedures for 2005.

Coders must distinguish AAA repair codes according to the type of prosthesis the surgeon places: aorto-aortic tube (34800), modular bifurcated prosthesis with one docking limb (34802), unibody bifurcated prosthesis (34804), or aorto-uniiliac or aorto-unifemoral (34805).

"Two docking limbs" is the key phrase: The new variation, 34803 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [two docking limbs]), describes a prosthesis similar to 34802, but with two, rather than a single, docking limb, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.

In the operative report, "the surgeon could specify the brand (manufacturer) of the prosthesis, but a given manufacturer may have several models. To simplify, under operative procedure, I would state: 'Endograft repair of infrarenal AAA using modular bifurcated endograft with two docking limbs.' " Barone says.

Code 34803 replaces Category III code 0001T, which CPT has deleted for 2005.

In a nutshell: You'll have to be extra cautious to read documentation to be sure you know exactly which type of prosthesis the surgeon placed before selecting a code.

Look to 36475-36479 for Vein Ablation

You'll have more choices when the surgeon treats varicose veins. CPT 2005 adds four new codes to describe endovenous ablation, a technique that uses radiofrequency or laser energy to restrict blood flow to affected veins:

  • 36475 - Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated

  • +36476 - ... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure)

  • 36478 - Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated

  • +36479 - ... second and subsequent veins treated in a single extremity, each through separate access sites (list separately in addition to code for primary procedure).

    Report 36475 or 36478 only once per session: When reporting endovenous ablation, you should report only a single unit of either 36475 (radiofrequency) or 36478 (laser). For the second vein treated and each subsequent vein the surgeon ablates, you should select add-on codes 36476 or 36479, as appropriate. You should never report add-on codes such as 36476 or 36479 alone, says Tara L. Conklin, CPC, an instructor for CRN-Institute, a coding and reimbursement institution in New Jersey offering courses in reimbursement, medical billing and both outpatient and inpatient coding certification. 

    Example: The surgeon ablates three veins using a laser probe. Report 36478 for the first vein and 36479 x 2 for the second and third veins.

    Include Guidance: The above codes include all associated guidance to place the catheter that the surgeon advances the radio-frequency or laser probe into.
     
    Gain Precision for Anastomosis With 36818

    You don't have to rely on an unlisted-procedure code for arteriovenous anastomosis of the cephalic vein any longer: Just select 36818 (Arteriovenous anastomosis, open; by upper arm cephalic vein transposition).

    Previous editions of CPT included a code for arteriovenous anastomosis of the basilic vein (36819), but not for the cephalic vein - which caused many coders to use 36819 incorrectly for the cephalic vein.

    Carotid Transcatheter Stent Now Means 37215/37216

    Codes for transcatheter stent placement in a non-coronary vessel (37205-37208) gain two new companion codes with 37215 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; with distal embolic protection) and 37216 (Transcatheter placement of intravascular stent[s], cervical carotid artery, percutaneous; without distal embolic protection).

    The new codes specifically describe stent placement to treat carotid artery stenosis, and which the surgeon may perform "in patients replacing an open carotid endarterectomy [CPT code 35301]," Barone says.

    Differentiate with and without distal embolic protection: To distinguish between 37215 and 37216, you must know if the surgeon used a distal embolic protection device with the stent placement. Report 37215 only if the surgeon specifically notes that he used such a device and you can provide supporting documentation for the insurer.

    Distal embolic protection devices are sold under the brand names PRIDE, CAPTIVE and others. The surgeon places the device to trap particle debris (also called plaque or thrombi) in the vein. 

    New Codes Mean Revisions for 37205/37206

    The addition of 37215/37216 means you should not use 37205/37206 for stent placements in carotid vessels. To further accentuate this point, CPT has revised the descriptors for 37205/37206, along with their companion radiologic supervision and interpretation code:

  • 37205 - Transcatheter placement of an intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous; initial vessel

  • + 37206 - ... each additional vessel (list separately in addition to code for primary procedure)

  • 75960 - Transcatheter introduction of intravascular stent(s) (except coronary, carotid, and vertebral vessel), percutaneous and/or open, radiological supervision and interpretation, each vessel.

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