Radiology Coding Alert

New codes added in CPT Codes 2001 to describe endovascular repair of abdominal aortic aneurysms (AAA) are generating great enthusiasm among interventional radiologists. The new codes allow reimbursement for this revolutionary treatment option, which uses minimally invasive techniques. Previously, AAA repair was achieved surgically, through large abdominal incisions, interruption of normal blood flow and extensive vascular suturing.

With the excitement, of course, comes the challenge of learning a new set of codes as well as deciphering how to report them correctly for optimum reimbursement. The new endovascular codes are intended to be used as component codes and have been designed to allow for maximum coding flexibility. Most of the procedures will require the efforts of two physicians usually a vascular surgeon and an interventional radiologist and each new code appropriately describes a distinct portion of the procedure. This allows each physician to report only the portions of the procedure he or she performs.

Nonetheless, the new codes bring with them one particular idiosyncrasy, says Donna Younes, BS, CPC, clinical practice manager in radiology for the University of Washington Medical Center and Harborview Medical Center in Seattle. Despite the fact that two physicians will most likely be involved in the procedure, she points out, none of the codes currently may be used with the co-surgeon modifier (-62, two surgeons).

Component Codes Reflect Stages

Endovascular repair procedures involve several stages, and radiology coders will choose component codes for services provided at each stage:

1. Vascular access
2. Catheterization
3. Placement of endovascular device

In addition, coders must consider radiology supervision and interpretation (RS&I) services, as well as placement of additional extensions or cuffs if the main device isnt long enough to compensate for leaks at either end of the repair.

Stage 1: Vascular Access

Endovascular repair procedures begin with open exposure of an artery to allow introduction of the repair device into the arterial system. Generally, this incision is made in the femoral artery in the groin area, explains Chris Sari, CPC, quality assurance manager for Advanced Radiology, which provides support to about 80 physicians, 24 freestanding facilities and eight hospitals in the Baltimore area. Alternately, if the femoral artery is diseased or very small, this incision will be made in the iliac artery. Codes describing vascular access are:

CPT 34812 open femoral artery exposure for delivery of aortic endovascular prosthesis, by groin incision, unilateral; and

CPT 34820 open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral.

If both femoral arteries or both iliac arteries are exposed, coders would append modifier -50 to indicate that the procedure was bilateral, Sari says.

Stage 2: Catheterization

No new codes were introduced [...]