General Surgery Coding Alert

Look for move from Category III to Category I.

You can ditch 0078T-+0081T beginning Jan. 1, 2014. That’s when CPT® 2014 unleashes eight new codes for reporting abdominal aortic aneurysm (AAA) repair using fenestrated endoprosthesis.

Your general and vascular surgeons face deleted and added codes that you need to know about to properly code these procedures. Make sure you have the chops to code fenestrated endovascular aortic aneurysm repair (FEVAR) in 2014 with the following helpful tips.

Tip 1: Forget the Outgoing Category III Codes

CPT® 2013 required separate Category III codes to report the surgical component and the radiological component of FEVAR procedures. You used the primary codes for the initial prosthesis placement and the add-on codes for the extension prosthesis in each visceral branch, as follows:

• 0078T — Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral branches (superior mesenteric, celiac and/or renal artery[s])
• +0079T — Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch (List separately in addition to code for primary procedure)
• 0080T — Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels (superior mesenteric, celiac and/or renal artery[s]), radiological supervision and interpretation
• +0081T — Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch, radiological supervision and interpretation (List separately in addition to code for primary procedure).

But CPT® 2014 deletes these four codes, so you won’t report the procedures that way beginning Jan. 1. Instead, you’ll have eight new Category I codes in their place.

Tip 2: Make Way for New Category I Codes

Unlike the deleted Category III codes, the new Category I codes include endovascular repair and radiological supervision and interpretation (S&I). You’ll also have new guidelines and instructions to help you properly code these services.

The move from Category III to Category I is a positive one, notes Marchelle Cagle, CPC, CPC-I, CMOM, of Alabama-based Cagle Medical Consulting. The move suggests the Category III AAA/FEVAR codes were used enough to show that the services deserved Category I codes, which “are more easily processed and recognized by the insurance payers,” she says. Plus, Category I codes typically have higher reimbursement than Category III codes, Cagle adds.

New way: The 2014 codes have a different structure than the Category III codes. In addition to bundling surgical and radiological components, each code is specific regarding the number of visceral arteries involved and the area of the aorta repaired.

Tip 3: Count Aorta Sections and Visceral Endoprostheses

For you to properly use the new codes, two key pieces of information should be in the surgical report. “You’ll need to identify the aorta section involved in the procedure, as well as the number of endoprostheses from the op report,” says Lynn Woolard, practice manager with General and Vascular Surgery, Ltd., in Elgin, Ill.

Look at the new codes here, divided into two code families by aorta section:

Visceral Aorta: Codes 34841-34844 refer to only the visceral portion of the aorta:

• 34841 — Endovascular repair of visceral aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)
• 34842 — … including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
• 34843 — … including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
• 34844 — … including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).

Visceral Aorta and Infrarenal Abdominal Aorta: Use codes 34845-34848 when both the visceral and infrarenal abdominal areas of the aorta are involved:

• 34845 — Endovascular repair of visceral aorta and infrarenal abdominal aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma,
  
• or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)
  
• 34846 — … including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34847 — … including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34848 — … including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
  

Codes 34845-34848 apply to an endograft that extends from the visceral aorta, through the infrarenal aorta, and into the common iliacs, including docking limbs and stent graft extensions that end in the common iliacs.

Coder tip: The op report must document fenestration before you can use any of these codes. The endograft is not fenestrated if the surgeon simply tailors the top or bottom edge by creating a “scallop” to better fit the anatomy. To properly use these codes, the endograft must have an actual “window” fitted to the patient’s anatomy.