General Surgery Coding Alert

Drop some radiology codes for new, comprehensive service descriptors.

If your surgeons perform endovascular repair, delivery, and extension procedures, you have a host of new, revised, and deleted codes to contend with in 2018.

Although the changes may be a lot to learn, let us help you focus on how the revisions can actually streamline your coding if you follow our expert tips.

Stop Using Endovascular Repair Codes; Choose From 8 New Options

Currently, you report the following endovascular repair codes, which CPT^® 2018 will delete, effective Jan. 1:

• 34800 through 34805 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection ...), and
• +34806 (Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation, instrument calibration, and collection of pressure data (List separately in addition to code for primary procedure)).

Instead, you'll need to report the following new codes next year in place of 34800-34806:

• 34701 and 34702 (Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft ...)
• 34703 and 34704 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac ...)
• 34705 and 34706 (Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft ...).
• 34707 and 34708 (Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft ...).

Rupture key: For all the above code pairs, you will report the first code in the pair (34701, 34703, 34705, and 34707) for "other than rupture," according to the code descriptors. For 34702, 34704, 34706, and 34708, you will report for rupture, according to the code descriptors.

Required components: These new, all-encompassing codes include each of these components: the pre-procedure sizing and device selection; the catheterization; the radiological supervision and interpretation; and the endograft.

"I find it ideal and less messy to use a single component code when a procedure is provided by one physician and/or facility department," commented Christina Neighbors, MA, CPC, CCC, coding quality auditor for Conifer Health Solutions Coding Quality & Education Department, in response to the new codes.

However, Neighbors adds that when multiple physicians and/or a hybrid lab are involved, there could be coding challenges.

For example: The radiologist provides the radiology portion of the procedure, and the vascular surgeon provides the surgery portion of the procedure, which now requires multiple components to capture the complete procedure.

Revision: CPT^® 2018 also revises an endovascular-repair Category III code to be all-inclusive, as follows (underline and strike through illustrate changes):

0254T (Endovascular repair of iliac artery bifurcation (eg, aneurysm, pseudoaneurysm, arteriovenous malformation, trauma, dissection) using bifurcated endoprosthesis endograft from the common iliac artery into both the external and internal iliac artery, including all selective and/or nonselective catheterization(s) required for device placement and all associated radiological supervision and interpretation, unilateral).

Remember, Category III codes are temporary codes that describe emerging technology, services, and procedures. The primary purpose of these codes is to allow for data collection, which in turn provides information for evaluating the effectiveness of new technologies and the formation of public and private policy.

Look to These Codes for Extension Prosthesis Placement

Currently, you can report 34825 and 34826 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection ...), but CPT^® 2018 will delete these codes.

Additions: For 2018, you will report the following codes in place of 34825 and 34826:

• +34709 (Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer...)
• 34710 and +34711 (Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration ...).

Required components: Codes 34709-34711 include the following components: pre-procedure sizing and device selection; catheterization(s); all associated radiological supervision and interpretation; and treatment zone angioplasty/stenting.

CPT^® 2018 Crosses Out 75952-75954

Because many of the new codes include radiological supervision and interpretation, you shouldn't be surprised that CPT^® 2018 also deletes the following radiological codes in the 70000 range:

• 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation)
• 75953 (Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery aneurysm, pseudoaneurysm, or dissection, ...)
• 75954 (Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio-iliac tube endoprosthesis...).

In the place of 75952-75954, you will report a code from the 34701 through 34711 range or category III code 0254T.

Mark Down These Delivery to Endograft, Endo Prosthesis Additions

CPT^® 2018 adds the following codes for delivery to the endograft and delivery of endovascular prosthesis:

• 34712 (Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation)
• +34713 (Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure))
• +34714 (Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure))
• +34715 (Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure))
• +34716 (Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass ...).

Revisions: You'll notice that the new codes are primarily "add-on" codes, meaning that you will need to list them in addition to the appropriate code for the primary procedure. CPT® 2018 also revises several existing delivery codes to make them add-on codes, so that you'll need to be sure to use the existing codes the same way. See the add-on and other revisions in the following codes (underline and strike through illustrate changes):

• +34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure))
• +34820 (Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, unilateral (List separately in addition to code for primary procedure))
• +34833 (Open iliac artery exposure with creation of conduit for delivery of aortic or iliac endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure))
• +34834 (Open brachial artery exposure to assist in the deployment of aortic or iliac endovascular prosthesis by arm incision, unilateral for delivery of endovascular prosthesis, unilateral (List separately in addition to code for primary procedure)).