CCI, Medicare and CPT Weigh In on Abdominal Endograft
Published on Fri Feb 01, 2002
The road to coding endografts for treatment of abdominal aortic aneurysms (AAA) has been full of twists and turns ever since CPT introduced a "family of component procedures" that includes 12 different codes for AAA repair and associated procedures, with the type of prosthesis used, the route taken and the method used to position the prosthesis in the aorta distinguishing one code from another.
The struggle that physicians and payers have been engaged in over coding, payment and coverage of AAA endograft billing procedures may be behind some of the new edits appearing in Correct Coding Initiative version 8.0 (CCI 8.0), the introduction of Category III CPT codes for associated procedures, and the recent Medicare physician fee schedule update covering co-surgery.
Other factors that may have led to these changes include unanticipated problems with the prostheses, as well as the introduction of new devices associated with AAA endovascular repair since the codes were unveiled in 2001.
CCI Edits
CCI 8.0 includes 169 edits related to AAA endovascular repair codes valid Jan. 1-March 31, 2002.
Most of these edits bundle these repairs with other procedures, such as open aortic aneurysm and blood vessel repair, open and percutaneous angioplasty, and a variety of catheterizations or needle introductions.
"These new edits are a response to the coding confusion brought about by the introduction of the codes last year," says Diane Elvidge, CPC, a coding specialist with Princeton Reimbursement Group in Minneapolis. "Many of the edits are obvious, like those involving endovascular and open repair. But misuse of the codes also stems from poor understanding of the procedure or vague descriptions in the operative report by surgeons."
Another reason for the number of new edits, Elvidge speculates, may be the number of mechanical and operational difficulties with the devices. "There were many problems with these devices in 2001, including some that required recall," Elvidge says. "As a result, it is likely that many more conversions to open procedures were performed than anticipated."
A surgeon performing an endovascular procedure may be forced to convert to open because, for example, the device breaks or becomes twisted. Elvidge says the edits have been introduced to ensure that the correct code is billed in this case, 34830 (open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis), 34831 ( aorto-bi-iliac prosthesis) or 34832 ( aorto-bifemoral prosthesis) rather than an open aneurysm repair code.
Meanwhile, 34812 (open femoral artery exposure for delivery of aortic endovascular prosthesis, by groin incision, unilateral) and 34820 (open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral) now bundle 36245-36247 (selective catheter placement, arterial system; first-, [...]
