On Demand - Coding for Endovascular and Open Aneurysm Repair-Questions & Answers

Questions & Answers

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In this Q&A session on coding for endovascular and open aneurysm repair, several questions are addressed:<br /><br />1. Regarding code 34812, which has a maximum unit of one (MUE), Medicare CMS allows the use of modifier 50 to indicate bilateral performance, even though this contradicts CPT guidelines. Some commercial carriers may allow reporting of two units or reporting twice.<br /><br />2. When embolization coils are placed in the internal iliac during an EVAR, the correct code to use is 37242, regardless of whether it is done during the EVAR procedure or at another session post EVAR.<br /><br />3. If a provider creates fenestrations off table with nitinol rings during the placement of a physician-modified thoracic tube graft to treat an abdominal aortic aneurysm with visceral involvement, it is still coded as a fenestrated graft. Many providers create their own FEVAR device.<br /><br />4. If an EVAR has been done previously and the provider needs to convert to open repair, either in the same session or at a different session, the appropriate code to use is 34831. A modifier 78 should be used if the patient is still in the 90-day global period.<br /><br />5. In cases where an aneurysm is a "contained" rupture, whether it is billed as a ruptured aneurysm depends on the nature of the rupture. If it is a chronic pseudoaneurysm, it is not billed as a ruptured aneurysm. However, if it is a new onset of pain and/or CT shows the aneurysm is ruptured but contained within the peritoneum, it is still considered a ruptured aneurysm. It is advisable to consult with the provider for clarification.<br /><br />6. Ultrasound guidance during percutaneous access and closure can be billed as code 76937 if a sheath size smaller than 12 French is used. Once a sheath size of 12 French or greater is used, code 76937 cannot be billed as it bundles with the procedure. Additionally, if cutdowns are performed, code 76937 is not appropriate.<br /><br />7. The separately billable catheter placement with aneurysm repairs depends on the type of repair being performed. For EVAR and FEVAR, selective cath placement is separately billable if the cath is placed outside the treatment zone. For TEVAR, non-selective or selective cath placement is separately billable with code 36200 or the appropriate vessel outside the aorta.

Keywords

coding

endovascular

open aneurysm repair

code 34812

embolization coils

internal iliac

fenestrations

abdominal aortic aneurysm

convert to open repair

ruptured aneurysm