General Surgery Coding Alert

Question: For a patient with an infrarenal aorta aneurysm that had not ruptured, our surgeon used an aortic tube endograft to repair the vessel. The procedure involved additional stenting in the right renal artery. How should we code this case?

Nebraska Subscriber

Answer: You should code the case using new code 34701 (Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer)).

Notice that the code is very similar to 34702 (...for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)), but you should reserve this code for a rupture.

You should not report any additional codes for the service you describe, even for the additional stenting.

Here's why: These endograft codes, new in CPT^® 2018, include each of these components: the pre-procedure computerized mapping involved in sizing and device selection; the catheterization; the radiological supervision and interpretation; and the endograft itself.

Also notice that the codes define a broader treatment area than was included in earlier, deleted codes. Specifically, extended and additional stenting in the same vessel family is now included in the treatment site definition, where previously it was more narrowly defined as the original affected vessel area. That means you should not separately bill for the stenting in the right renal artery, because the 34701 procedure code includes that work.