Coding guidelines Endovascular repair / Cardiology coding

Ascending aorta graft

When ascending aortic disease involves the aortic arch, an aortic hemiarch graft may be necessary in conjunction with the ascending aortic graft and may be reported with add-on code 33866 in conjunction with the appropriate ascending aortic graft code (33858, 33859, 33863, 33864).

Aortic hemi arch graft requires all of the following components:

•  Either total circulatory arrest or isolated cerebral perfusion (retrograde or antegrade);
• Incision into the transverse arch extending under one or more of the arch vessels (eg, innominate, left common carotid, or left subclavian arteries);
•  Extension of the ascending aortic graft under the aortic arch by construction of a beveled anastomosis to the distal ascending aorta and aortic arch without a cross-clamp (an open anastomosis).

Use 33866 for aortic hemiarch graft when performed in conjunction with the ascending aortic graft codes 33858, 33859, 33863, 33864.

Code 33871 describes a complete transverse arch graft placement, and is not used to report an aortic hemiarch graft procedure.

(Do not report 33871 for aortic hemiarch graf)

Endovascular Repair of Descending Thoracic Aorta ( 33880-33891)

The following procedures are included procedure cannot be report with (33880-33891)

• All device introduction
• Manipulation
• Positioning
• Deployment.

All balloon angioplasty and/or stent deployment within the target treatment zone for the endoprosthesis, either before or after endograft deployment, are not separately reportable.

The following procedures can be reported separately

• • Open arterial exposure and associated closure of the arteriotomy sites (eg, 34714, 34715, 34716, 34812, 34820, 34833, 34834),
  • Introduction of guidewires and catheters (eg, 36140, 36200- 36218),
  •  Extensive repair or replacement of an artery (eg, 35226, 35286)
  • CPT code 33880 – Endovascular repair of descending thoracic aorta. Graft covers the left subclavian artery origin.
  • CPT 33881 – Not involving coverage of left subclavian artery origin.
  • Note: CPT 33880 and 33881 include placement of all distal extension (33886).
  • Only proximal extensions (33883 & 33884) may be coded separately
  • For Radiologic S&I – CPT 75956 to 75959 may be reported separately

The following Services cannot be reported separately for better coding

• • All device introduction
  • Manipulation
  • Positioning
  • Deployment
  • Balloon Angioplasty and stent deployment before/after endograft.
  • The following services may be reported additionaly
  • Open arterial exposure and closure of the arteriotomy site (34812, 34820, 34833, 34834)
  •  Introduction of guidewires and catheters (36140, 36200 – 36218)
  • Extensive repair/replacement of an artery (35226, 35286)
  • Transposition of the subclavian artery to carotid and carotid-carotid bypass performed in conjunction (33889, 33891) should be coded separately.
  • Other Interventional procedures like (Eg, Innominate, carotid, subclavian, visceral, iliac artery angioplasty, stent, embolization, intravascular ultrasound) should be additionally reported

Endovascular Repair of an Abdominal aorta and/or iliac arteries

Infrarenal abdominal aorta with or without extension into the iliac artery

Due to following condition doctor may perform the Infrarenal abdominal aorta

• • Aneurysm,
  • Pseudoaneurysm,
  • Dissection,
  • Penetrating ulcer,
  • or traumatic disruption

Iliac artery alone

• • If the condition Aneurysm, pseudoaneurysm, arteriovenous malformation/trauma should be coded 34707 and 34708
  • For treatment of atherosclerotic occlusive disease in the iliac artery(ies) with a covered stent(s), see 37221, 37223
  • atherosclerotic occlusive disease in the aorta code CPT code 37236, 37237

• • bilateral iliac artery repair using iliac artery tube endografts, report 34707 or 34708 with modifier 50 appended.
  • Decompressive laparotomy CPT code 49000 may be reported separately abdominal compartment syndrome with o 34702, 34704, 34706, or 34708

The treatment zone for endograft procedures

 

Angioplasty, endovascular stent placement, embolization may be reported separately if it is performed outside the treatment zone

Vessel that contains the endograft (main body, docking limbs, and/or extension), Other Interventional Procedures (Balloon, stent, embolization etc) outside the treatment zone may be reported separately.

• • CPT 34701 and 34702 – Treatment zone is the infrarenal aorta
  • CPT 34703 and 34704 – Treatment zone is infrarenal aorta with an ipsilateral common iliac artery.
  • CPT 34705 and 34706 – Treatment zone is infrarenal aorta with both common iliac arteries.
  • CPT 34708 and 34709 – Treatment zone is iliac arteries.
  • For bifurcated iliac branch device – 0254T
  • A chronic contained rupture is considered as pseudoaneurysm, Should be reported as without rupture codes (34701/34703/34705/ 34707).
  • Acute hemorrhage should be considered as a rupture – CPT 34702/34704/34706/34708
  • CPT 34709 – Extension prosthesis, in internal iliac, external iliac or common femoral artery or in abdominal aorta proximal to the renal artery
  • CPT 34709 should be reported once per vessel treated.
  • Endograft distal extensions that terminate in the common iliac artery are included in CPT 34703, 34704, 34705, 34706, 34707 and 34708
  • Similarly, the proximal extension that terminates in aorta below the renal artery also included in CPT 34703, 34704, 34705, 34706.

• • CPT 34710 and 34711 – delayed placement of distal/proximal extensions

Included services for Best and accuracy coding

 

1. 1. Pre-procedure sizing and device selection
   2. All nonselective catheterization
   3. All associated Radiological S&I
   4. Treatment zone angioplasty / stent
   5. CPT 34710 and 34711 should be reported once per vessel treated. (Multiple endograft extension placed in the same vessel would be reported once)

Included and exclude services:

• Nonselective catheterization is included in CPT 34701 – 34708
• CPT 34709, 34710, 34711 include the nonselective introduction of guidewires and catheters into the treatment zone from peripheral artery access.

• Balloon and stent within the treatment zone of the endograft either before or after endograft deployment is included

• Fluoroscopic guidance, radiological S&I and all intraprocedural imaging and completion angiography (Confirm position, detect endoleak) in conjunction with endograft repair are included.
• Selective catheterization of hypogastric artery, renal artery, and/or families outside the treatment zone can be coded separately.

1.  For Fenestrated Endovascular repair of the visceral aorta (34841- 34844)

For Fenestrated Endovascular repair of the visceral aorta and concomitant infrarenal abdominal aorta (34845 – 34848)

CPT 34839 – Physician planning and sizing for a patient-specific fenestrated visceral aortic endograft.

Documentation should support

• Minimum 90 min of physician time in planning
• No need to be a continuous-time
• Should not be reported on the day before or day of the fenestrated endovascular repair procedure.
• Fenestrated Endovascular repair of the visceral aorta (34841- 34844)
• Proximal endoprosthesis that span from the visceral aortic component to one, two, and three or four visceral artery origins and distal extent limited to the infrarenal aorta.
• For Fenestrated Endovascular repair of the visceral aorta and concomitant infrarenal abdominal aorta (34845 – 34848)
• Fenestrated endoprosthesis that spans from the visceral aorta through the infrarenal aorta into the common iliac arteries.
• The infrarenal component may be a bifurcated unibody device, a modular bifurcated docking system with docking limbs or an aorto-uniiliac or aorta-unifemoral device.
• CPT 34845 – 34848 includes placement of unilateral or bilateral docking limbs.
• Additional stent graft extensions that terminate in the common iliac artery are included in the CPT 34845 – 34848.
• If the distal extension prosthesis that terminates in the internal iliac, external iliac or common femoral artery – CPT 34825 and 34826 would be reported separately.

Included services with CPT 34841 – 34848:

 

• Introduction of guidewire and catheters in the aorta and visceral and/or renal arteries is included. Exception: catheterization of the hypogastric artery and /or arterial families outside the treatment zone of the graft may be separately reported.
• Balloon angioplasty within the target treatment zone of the endograft, either before or after endograft deployment is included.
• Fluoroscopic guidance and radiological supervision and interpretation in conjunction with fenestrated endovascular aortic repair are included.

  Additionally billable services:

• Exposure of the access vessels (Eg, 34812)
• Extensive repair of an artery (Eg, 35226, 35286)
• Report concomitant endovascular treatment of the descending thoracic aorta (33880-33886 and 75956-75959) with 34841 – 34848
•  Other Interventional procedures performed at the time of fenestrated endovascular abdominal aortic aneurysm repair should be coded additionally. (Eg: Balloon angioplasty or stenting or arterial embolization or intravascular ultrasound of artery outside the Endoprosthesis target zone, done before or after deployment of graft)

CPT 34841 – Visceral aorta, Endovascular repair, One visceral artery

CPT 34842 – including two visceral artery

CPT 34843 – including three visceral artery

CPT 34844 – including four or more visceral artery

CPT 34845 – Visceral aorta and infrarenal abdominal aorta

Endovascular repair, one visceral artery.

CPT 34846 – including two visceral artery

CPT 34847 – including three visceral artery

CPT 34848 – including four or more visceral artery