Abdominal Aortic Aneurysm Repair – Report the Correct CPT Codes

Repair of abdominal aortic aneurysm (AAA) is one of the many procedures that a medical coding and billing company helps cardiovascular surgeons document, code and report. Aneurysms are the ballooning and weakening of the arterial wall and can occur along the entire length of the aorta. An infrarenal AAA can occur in any part of the abdomen, including the intestines and kidneys. Recent reports indicate that ruptured AAA is the 13^th leading cause of death in the United States, causing an estimated 15,000 deaths per year (www.medscape.com).

Symptoms

Men who are older than 65 years and have peripheral atherosclerotic vascular disease are at the greatest risk of AAA. Some aneurysms stay small, while others grow. As they grow slowly without any symptoms, abdominal aortic aneurysms are difficult to detect until they rupture. Symptoms of an expanding AAA include:

• Sudden, severe, and constant low back
• Flank, abdominal, or groin pain
• A pulse near the belly button

Routine physical examination may indicate a palpable and pulsatile abdominal mass.

 AAA Management

 Targeted ultrasound screening is considered an effective and economical means of preventing aortic aneurysm rupture. The indication for repair includes either symptomatic aneurysms or aneurysms with a diameter greater than 5.4 cm.

Abdominal aortic aneurysms (AAAs) are surgically repaired. While elective surgical repair is done for an unruptured aneurysm, a ruptured AAA calls for emergency surgical repair for a ruptured AAA. Treatment methods include:

• Traditional open laparotomy
• Minimally invasive methodologies
• Placement of endovascular stents

Currently, endovascular aneurysm repair (EVAR) is the main treatment approach for the repair of infrarenal aortic aneurysms. EVAR involves inserting a graft into the lumen of the aorta to exclude the aneurysm sac. It is less invasive than open surgical repair and involves shorter recovery times and hospital stays, and improved short-term morbidity and mortality outcomes.

Reporting AAA Repair

To secure appropriate reimbursement for abdominal aortic aneurysm repair, providers need to report the correct codes. In recent times, new codes have been added to reflect technological advances and to allow bundling of codes that could be reported together.

Recently Added CPT Codes for EVAR and/or Iliac Arteries

In 2018, 16 new codes (34701–34716)were added for endovascular repair of abdominal aorta and/or iliac arteries and four related codes (34812, 34820, 34833, and 34834) were revised. The base codes are as follows:

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)

34702 for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

34703 Endovascular repair of infrarenal aorta and/or iliac artery (ies) by deployment of an aorto-uni-iliac endograft… for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer)

34704 for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

34705 Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac 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 iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer)

34706 for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

34707 Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation)

34708 for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)

 CPT Codes to Report Open/Direct Repair of Infrarenal Aortic Aneurysm

In the case of failed endovascular aortic repair, patients will require open surgery. The relevant CPT codes for Open repair of infrarenal aortic aneurysm are as follows:

 34830 – Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis

34831 – Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis

34832 – Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis

35081 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta

35082 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta

35091 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)

35092 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)

35102 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)

35103 – Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)

With multiple codes, complex reporting guidelines, and varying payer requirements, many providers now prefer to outsource medical billing and coding to an expert. Partnering with a reliable medical billing and coding company can ensure accurate reporting of AAA using the correct CPT and ICD-10 codes for appropriate reimbursement.