Abdominal aortic aneurysm (AAA) refers to the stretching and blood-filled bulging in a part of the aorta that runs through your abdomen. The aorta runs from your heart through the center of your chest and abdomen. It is the main blood vessel that supplies oxygen-rich blood from the heart to the rest of the body like abdomen, pelvis and legs. AAA occurs when an area of the aorta becomes very large or balloons out. Being the largest blood vessel, the aorta can cause serious problems if it enlarges or ruptures. This can lead to severe pain and massive internal bleeding, or hemorrhage. An AAA can be risky, if it is not detected early and treated correctly. Depending on the size of the aneurysm and its speed of growth, treatment modalities varies. If the physician determines that the patient’s aneurysm is small and not growing fast, it is safe to watch the aneurysm carefully. On the other hand, if the aneurysm becomes large and is about to rupture, emergency surgery may be the safest choice. In some cases, physicians may put in a type of graft (called a stent) to fix the aneurysm without doing major surgery. Medical coding services provide great assistance for physicians when it comes to documentation requirements. Accurate diagnosis and documentation are crucial for error-free billing and optimal reimbursement.

According to reports from Medscape.com (2019 statistics), ruptured AAA is the 13th leading cause of death in the United States, causing an estimated 15,000 deaths per year. The frequency rate of AAA ranges from 0.5% to 3.2%. Abdominal aortic aneurysms (AAAs) are generally classified on the basis of their size and the speed at which they are growing. Small or slow growing AAAs (less than 5.5 centimeters) have a low risk of rupture. On the other hand, large or fast-growing AAAs (greater than 5.5 centimeters) are more likely to rupture than small or slow-growing aneurysms. A rupture can cause internal bleeding and other serious complications. The size and speed of growth are the two main factors that help predict the health effects of the aneurysm and decide further treatment options. The larger the aneurysm, the more likely it is to be treated with surgery. These types of aneurysms also need to be treated if they are causing symptoms or leaking blood. Physicians often recommend that it is safer to monitor the aneurysms with regular abdominal ultrasounds than to treat them.

Causes and Symptoms

The cause of AAAs is unknown. However, certain factors have been shown to increase the risk factors associated with the condition and these include – smoking, people with atherosclerosis (hardening of the arteries), vascular inflammation (vasculitis), family history of heart diseases/conditions, high cholesterol/ blood pressure, previous aneurysms (in other arteries in the legs or chest), bacterial fungal infection in the aorta and obesity. In addition, men who are older than 65 years and have peripheral atherosclerotic vascular disease are at the greatest risk of suffering AAA. Some aneurysms remain small, while others grow. As they grow slowly without any symptoms, abdominal aortic aneurysms are difficult to detect until they rupture. In some cases, certain types of aneurysms will never rupture. Common symptoms of an enlarging aneurysm include –

  • Sudden pain in your abdomen or back
  • Pain that spreads from your abdomen or back to your pelvis, legs, or buttocks
  • A pulsating feeling near the navel
  • Dizziness and shortness of breath
  • Increased heart rate

Diagnosis, Screening and Management

Diagnosis of AAA starts with a detailed clinical examination, wherein the physician may check for any specific bulge in your abdomen. Diagnostic imaging tests like chest X-ray, abdominal ultrasound, CT scan of the abdomen and abdominal MRI may be preformed to analyze the nature of bulge. Treatment modalities for AAAs involve careful medical monitoring or surgery (to prevent aneurysm from rupturing). Physicians may perform surgery to repair or remove the damaged tissue depending on the size, rate of growth and the location of the aneurysm. Regular imaging tests will be performed to check the size of aneurysm.

For large or fast-growing AAAs(greater than 5.5 centimeters) which are more likely to rupture, surgical procedures like – open abdominal surgery and endovascular surgery will be performed (based on severity of symptoms and size of growth). Open abdominal surgery is performed if the aneurysm is very large or has already ruptured. Endovascular aneurysm repair (EVAR) on the other hand, uses a graft to stabilize the weakened walls of your aorta. Recovery from open abdominal surgery may take up to 6 weeks, whereas endovascular surgery may only take about 2 weeks to recover completely.

Screening Guidelines

Most aortic aneurysms do not cause any specific symptoms until they rupture, which is why they are so dangerous. AAAs progressively dilate over time. One of the biggest concerns is that it can rupture and cause significant internal bleeding, which can be fatal. Therefore, it is imperative to screen those people at risk, and once diagnosed, the size of a patient’s AAA should be monitored periodically. Large AAAs should be surgically repaired before they rupture.

The primary way of screening for AAA includes an abdominal ultrasound. This screening test is easy to perform, non-invasive, does not involve radiation, and is highly accurate in detecting AAA. The potential benefit of screening for AAA is detecting and repairing it before it ruptures which requires surgery. When filing claims for screening tests, use the following CPT code to ensure proper billing and reimbursement –

  • 76706 – Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)

The U.S. Preventive Services Task Force’s (USPSTF) recently published recommendations for abdominal aortic aneurysm screening and how to code for this potentially life-saving test. The new screening guidelines apply to adults aged 50 years or older who do not have any signs or symptoms of AAA.

The screening guidelines include –

  • Men aged 65 to 75 years who have never smoked should have a one-time for abdominal aortic aneurysm (AAA) with ultrasonography. Men aged 60 years and older with a family history of abdominal aortic aneurysms should consider regular screening for the condition.
  • Clinicians selectively offer screening for AAA in men aged 65 to 75 years, who have never smoked rather than routinely screening all men in this group.
  • The USPSTF recommends against routine screening for AAA with ultrosonography in women who have never smoked and have no family history of AAA.

Medical Codes to Use

Vascular medical coding involves the use of specific ICD-10 and CPT codes to document any such conditions, including abdominal aortic aneurysms (AAA). To secure appropriate reimbursement for abdominal aortic aneurysm repair, providers need to use the correct medical codes.

ICD-10 Codes

I71 – Aortic aneurysm and dissection

  • I71.0 – Dissection of aorta
    • I71.02 – Dissection of abdominal aorta
    • I71.03 – Dissection of thoracoabdominal aorta
  • I71.3 – Abdominal aortic aneurysm, ruptured
  • I71.4 – Abdominal aortic aneurysm, without rupture
  • I71.5 – Thoracoabdominal aortic aneurysm, ruptured
  • I71.6 – Thoracoabdominal aortic aneurysm, without rupture
  • I71.8 – Aortic aneurysm of unspecified site, ruptured
  • I71.9 – Aortic aneurysm of unspecified site, without rupture

CPT Codes

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 newly added CPT codes include –

  • 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/oriliac balloon occlusion, when performed (eg,for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)
  • 34703 – Endovascular repair of infrarenal aorta and/or iliacartery(ies) by deployment of an aorto-uni-iliacendograft 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)
  • 34704 -For rupture including temporary aortic and/oriliac 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 preprocedure 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 Repair of Infrarenal Aortic Aneurysm

In case of failed endovascular aortic repair, physicians will recommend open surgery. The relevant CPT codes include –

  • 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)

Reporting Abdominal Aortic Aneurysm (AAA) can be complex, with multiple codes and screening guidelines and payer requirements. Physicians need to ensure accurate and specific documentation so that coders and medical billing service providers can ensure accurate claim submission. A reliable vascular medical billing company will work along with physicians to make sure that everything is submitted correctly according to payer policies.

Disclaimer – The content in this blog is only for informational purposes and should not be seen as professional medical advice. OSI is only passing on information that is already published and does not accept any responsibility for any loss which may occur due to reliance on information contained in this blog.