General Surgery Coding Alert

Not all patients are candidates for endovascular AAA repair. Traditionally, graft repair of the aneurysm involves exposing the affected portion of the aorta with a large incision (via a transabdominal or retroperitoneal approach), temporarily occluding (stopping) the blood flow, opening the aneurysm, and inserting a tubular prosthesis. -The open procedures remain fairly straightforward,- Barone says.

You should report such open procedures using 35081 (Direct repair of aneurysm, pseudoaneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta) for repairs confined to the abdominal aorta or 35102 (- for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels) for repairs that involve the abdominal aorta and one or both iliac vessels.

Open repair following endovascular attempt calls for special code: Experienced coders know that if an open repair follows a -closed- procedure, such as when an open cholecystectomy follows an attempted laparoscopic cholecystectomy, you should report only the open procedure. But when the surgeon must perform an open AAA repair following an attempted endovascular repair (either during the same session or during the global period of the endovascular repair), you won't report the standard open repair codes and should instead rely on 34830-34832 (Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair-), depending on the type of prosthesis the surgeonultimately places (tube, aorto-bi-iliac or aorto-bifemoral).

If the open repair occurs during the global period of an earlier endovascular repair attempt, be sure to append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 34830-34832, as appropriate.