General Surgery Coding Alert

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 [...]