General Surgery Coding Alert

Manufacturers may make several type of prostheses, so rely on details, not trade names, to make the proper choice When reporting endovascular abdominal aortic aneurysm (AAA) repair, the most crucial piece of information you-ll need is the type of prosthesis the surgeon placed. Familiarize yourself with the five available types of prostheses, and you-ll choose the primary code for these procedures in a snap. Step One: Identify the Artery or Arteries Targeted As an initial step, you should determine if the surgeon places the prosthesis in the abdominal aorta only, or if a portion of the prosthesis extends into one or more of the iliac (or possibly renal) arteries.

-I would definitely encourage open communication between the surgeons and the medical coders about which specific type of endograft was placed,- says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.

As illustrated (Fig. 1), the abdominal aorta branches into the common iliac arteries below the renal arteries. If the abdominal aorta develops an aneurysm, or bulging due to a weakening of the artery walls, the surgeon may make an incision in the groin and, under fluoroscopic guidance, thread a catheter through the arteries to the aneurysm site. Using a stent, the surgeon will then guide the prosthesis into place via the catheter. When expanded, the prosthesis reinforces the artery wall, which prevents the aneurysm from further ballooning or bursting.

If the graft remains in the abdominal aorta only, without extending into either iliac (or renal) artery (Fig. 2,), you should choose 34800 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis), says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa. This describes placement of a single-piece, tube prosthesis without -docking limbs- (which we-ll discuss later).
Note: If the graft prosthesis does extend into one or more iliac (or renal) arteries, you-ll have to consider a few additional factors before you can choose the appropriate code.

Step Two: One or More Pieces? If the prosthesis extends into one or both iliac arteries (or possibly a renal artery), you must next determine whether the graft is made of one piece (unibody) or of several pieces that the surgeon places separately and joins together at the aneurysm site (modular).

-Some grafts are required to be constructed within the patient (modular), while others come already as one graft (unibody),- Barone says.

CPT describes two unibody prostheses, which differ according to whether the prosthesis enters one or both iliac arteries.

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