General Surgery Coding Alert

Endovascular repair of abdominal aortic aneurysms (AAA) involves a range of separately reportable procedures, depending on circumstances. In addition, CPT contains a specific code group to describe endoscopic-to-open conversions for aneurysm repair. By reviewing all the services the surgeon may provide, you can make use of all the available codes and ensure complete reimbursement. Independently Report Associated Procedures Placement of a prosthesis as described by 34800-34804 accounts for only a portion of the total procedure, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.

Although CPT specifies that balloon angioplasty (to inflate the prosthesis after it is placed) and stent deployment within the treatment zone (that is, the area in which the physician places the prosthesis) are bundled to the primary procedure code, other services are separately reportable. As noted in the December 2000 CPT Assistant , these include extensions cuffs (discussed last month), open surgical exposure of the femoral arteries (or, less often, the iliac arteries), catheter placement, radiological supervision and interpretation (when appropriate), "conversion" surgery, and other, less common separately reportable maneuvers. "Since each situation and aneurysm will be different, the specific codes reported will depend on the actual procedure performed and the circumstances involved in the repair," CPT Assistant further notes. Arterial Exposure Precedes Prosthesis Placement Now, all prosthetics approved by the U.S. Food and Drug Administration for endovascular AAA repair require surgical exposure of at least one artery (for a description of the various types of prosthetics, see General Surgery Coding Alert, April 2003). The surgeon must open the artery to introduce the prosthesis, which he or she will then maneuver into place at the site of the aortic aneurysm. The primary repair codes (34800-34804) do not include surgical exposure of arteries for device introduction. Therefore, you may report direct vascular access of the iliac or femoral arteries separately using 34812 (Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral) or 34820 (Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral), Hammer says, depending on which artery the physician accesses. Note that these are unilateral codes. If the surgeon must access arteries bilaterally (that is, one in each leg), be sure to append modifier -50 (Bilateral procedure) to the appropriate exposure code. Because of the additional work, Medicare carriers customarily pay such claims at 150 percent of the unilateral rate, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. Use Modifier -50 for Catheters If the physician introduces a catheter(s) into [...]