Endovascular Repair
For reporting purpose: Aorta anatomy
1. Thoracic aorta – From aortic valve to proximal to celiac artery origin.
2. Upper abdominal aorta – contains, celiac, superior mesenteric and renal arteries (Visceral aorta)
Endovascular Repair of Descending Thoracic Aorta
- Placement of endovascular graft for repair of the descending thoracic aorta (Aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption and intramural hematoma.
- CPT 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) can be billed separately if needed.
- For Radiologic S&I – CPT 75956 to 75959
These procedures include
· All device introduction
· Manipulation
· Positioning
· Deployment
· Balloon Angioplasty and stent deployment before/after endograft.
Additionally billable services,
· 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.
Note: For transcatheter placement of the wireless physiologic sensor in aneurismal sac – 34806
For analysis, interpretation and report of the implanted wireless pressure sensor – 93982
Endovascular Repair of an Abdominal aorta and/or iliac arteries
Infrarenal abdominal aorta with or without extension into the iliac artery
CPT 34701, 34702, 34703, 34704, 34705, 34706 describe introduction, positioning, deployment of an endograft for treatment of abdominal aortic pathology (with or without rupture) Eg; Aneurysm, pseudoaneurysm, dissection, penetrating ulcer, or traumatic disruption.
The endograft maybe
1. Aortic tube device
2. A bifurcated unibody device
3. A modular bifurcated docking system with docking limbs
4. An aorto-uni-iliac device
Iliac artery alone
CPT 34707 and 34708 describe introduction, positioning, deployment of an endograft for treatment of iliac artery pathology (with or without rupture). Eg; Aneurysm, pseudoaneurysm, arteriovenous malformation/trauma.
For atherosclerotic occlusive disease in the iliac arteries with a covered stent placement – CPT 37221, 37223
For atherosclerotic occlusive disease in the iliac arteries with a covered stent placement – CPT 37221, 37223
For atherosclerotic occlusive disease in the aorta with covered stent placement – CPT 37236, 37237
For isolated bilateral iliac artery repair – CPT 34707 or 34708 with modifier 50
Bilateral iliac artery repair with aorto-bi-iliac endograft – CPT 34705 or 34706
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:
1. Pre-procedure sizing and device selection
2. All nonselective catheterization
3. All associated Radiological S&I
4. Treatment zone angioplasty / stent
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:
1. 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.
2. Balloon and stent within the treatment zone of the endograft either before or after endograft deployment is included.
3. Fluoroscopic guidance, radiological S&I and all intraprocedural imaging and completion angiography (Confirm position, detect endoleak) in conjunction with endograft repair are included.
4. Selective catheterization of hypogastric artery, renal artery, and/or families outside the treatment zone can be coded separately.
5. Intravascular ultrasound (CPT 37252, 37253) performed during endovascular aneurysm repair can be coded separately.
6. Any open arterial exposure should be coded separately (34713, 34714, 34715, 34716, 34812, 34820, 34833, and 34834)
7. Extensive repair of the artery should be coded separately (35226, 35286, and 35371)
8. The cardiovascular bypass should be coded separately. If a conduit is converted into a bypass report the bypass (CPT 35665)
9. Arterial embolization to facilitate endovascular procedure should be coded separately (CPT 37242)
CPT 34712 – Transcatheter delivery of accessory enhanced fixation devices to the endograft (Eg: Anchor, screw) including all associated S&I. Note: Reported once per operative session
CPT 34713 – Percutaneous access and closure of a femoral arteriotomy for delivery of endovascular prosthesis through a large sheath (12 French or larger) Smaller than 12 French are included in procedures codes 34701- 34712. Note: Ultrasound 76937 is included in CPT 34713
Open repair of infrarenal aortic aneurysm
CPT 34830 – Tube prosthesis (open repair of infrarenal aortic) following unsuccessful endovascular repair.
CPT 34831 – aorto-bi-iliac prosthesis
CPT 34832 – aorto-bifemoral prosthesis
Fenestrated Endovascular repair
Based on the extent of the aorta treated, there are two sets of codes
A. For Fenestrated Endovascular repair of the visceral aorta (34841- 34844)
B. 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
* For Direct repair of aneurysm CPT 35001 - 35152
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