General Surgery Coding Alert

Until now, CPT did not include codes to describe endovascular repair of abdominal aortic aneurysms (AAA). Therefore, these procedures had to be billed using a single unlisted code, which limited the dollar value of the claim. CPT 2001, however, introduces 12 new codes many of which can be separately billed allowing for the possibility of significantly increased reimbursement for these procedures.

The codes describe the repair of the aneurysm and various associated procedures. In addition, the subsection of CPT in which the new codes appear includes an introduction noting two new radiology codes that may be billed with the repair under certain circumstances.

This new multiprocedural technique is performed on patients with an AAA, a life-threatening condition frequently associated with hypertension. The aneurysm is a bulge, or dilation, in the wall of the aorta resulting primarily from arteriosclerosis.

Unless a patient suffers from other conditions that make surgery too risky, surgery is indicated for patients with an AAA wider than 5-6 cm. Until recently, this meant open surgical repair using a direct transabdominal or retroperitoneal approach to the external surface of the aneurysm. Such procedures involve making a large incision to expose the aneurysm, temporarily occluding the blood flow, opening the aneurysm and inserting a tubular prosthesis within the open sac. These procedures often led to complications and involved high risk, particularly for ailing, elderly patients.

Because a large abdominal incision is not required, the endovascular approach is far less invasive. When an AAA is repaired in this way, a collapsed prosthesis is introduced through arteries in the groin (either femoral or iliac) and advanced into position under fluoroscopic guidance. After the prosthesis is positioned, a balloon inflates it to full size, and metal clips on the distal and proximal ends of the device latch onto the inside of the artery.

Note: Prior to surgery, the surgeon may determine that the patients anatomy will not permit this new technique (for example, the patients arteries may be too small to allow passage of the prosthetic device). In such cases, the open procedures (35081, direct repair of aneurysm, false aneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, false aneurysm, and associated occlusive disease, abdominal aorta; and 35102, direct repair of aneurysm, false aneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, false aneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels) would be performed.

Using the New Endovascular Repair Codes

The first three codes in the endovascular AAA repair subsection describe variants of [...]