General Surgery Coding Alert

Although you may find reporting endovascular repair of abdominal aortic aneurysms (AAA) challenging because you're unfamiliar with the unusual terminology that describes these procedures, you can better interpret operative notes, code successfully and earn a "perfect grade" every time by familiarizing yourself with the vocabulary and the code descriptors for 34800-34832 and related procedures. Endovascular Versus Open Procedures An AAA is a bulge in the aorta, usually due to a weakness or thinning of the vessel wall, which may be associated with a number of co-existing conditions, including smoking, hypertension and chronic lung disease, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock. 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. You should report such procedures as 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) or 35102 ( for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels) as appropriate to the vessels involved. In 2001, CPT added a series of codes (34800-34832 and 75952/75953) to report endovascular repair of AAAs and their associated procedures. Although not indicated for all patients, the endovascular approach is much less invasive and can reduce the risk of complications and/or morbidity as compared to an open procedure, Barone says. The surgery involves introducing a collapsed prosthesis through arteries in the groin (either femoral or iliac). Using guidewires and catheters and under fluoroscopic guidance, the physician positions the prosthesis (an endoluminal stent graft), which, when deployed, expands to a preset size to exclude the aneurysm from the circulation. Prosthesis Type Determines Code CPT designates three codes to describe the primary portion of endovascular AAA repair:
34800 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis
34802 using modular bifurcated prosthesis (one docking limb)
34804 using unibody bifurcated prosthesis. The crucial difference among these procedures is the type of prosthesis employed. Consequently, coders must be especially careful of terminology to guarantee proper code selection, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. Code 34800 describes placement of an endovascular tube graft in the aorta. To position the graft appropriately the surgeon may pass guidewires/catheters from both the left and right iliac arteries, however.

Code 34802 describes placement of a more complex prosthesis, which extends in the shape of an upside-down "Y" from the aorta into the right [...]