Cardiology Coding Alert

FEVAR moves from Category III to Category I in January.

Your visceral aorta repair coding options are about to get a little more detailed.

CPT® 2014 introduces codes 34841-34848 to replace the previously available Category III codes 0078T-+0081T for abdominal aortic aneurysm repair involving visceral branches. The codes are specific to the use of a fenestrated endoprosthesis.

Old way: The 2013 codes required separate codes to report the surgical component (0078T, +0079T) and the radiological component (0080T, +0081T). You used the primary codes for the initial prosthesis placement and the add-on codes for the extension prosthesis in each visceral branch:

• 0078T, Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral branches (superior mesenteric, celiac and/or renal artery[s])
  
• +0079T, Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch (List separately in addition to code for primary procedure)
  
• 0080T, Endovascular repair using prosthesis of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels (superior mesenteric, celiac and/or renal artery[s]), radiological supervision and interpretation
  
• +0081T, Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch, radiological supervision and interpretation (List separately in addition to code for primary procedure).
  

New way: The 2014 codes have a different structure. Surgery and radiological components are bundled into each code. Additionally, each code is specific regarding the number of visceral arteries involved and the area of the aorta repaired, as explained in the next section.

Count Aorta Sections and Visceral Endoprostheses for Accuracy

Visceral Aorta: Codes 34841-34844 refer to only the visceral portion of the aorta (bold added to emphasize visceral artery requirement):

34841, Endovascular repair of visceral aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)

• 34842, … including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34843, … including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34844, … including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])

Visceral Aorta and Infrarenal Abdominal Aorta: Codes 34845-34848 are appropriate when both the visceral and infrarenal abdominal areas of the aorta are involved (bold added to emphasize visceral artery requirement):

• 34845, Endovascular repair of visceral aorta and infrarenal abdominal aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery)
  
• 34846, … including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34847, … including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  
• 34848, … including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s])
  

Codes 34845-34848 apply to an endograft that extends from the visceral aorta, through the infrarenal aorta, and into the common iliacs, including docking limbs and stent graft extensions that end in the common iliacs.

2 Term Tips Help With Coding

Fenestrated: All of the new codes refer to a fenestrated endograft. Fenestrated means the endograft contains holes. The holes line up with the arteries branching from the aorta, preserving the blood flow and also allowing selective catheterization and placement of an endoprosthesis through the fenestration into the visceral branch. Another term for the repair procedure is FEVAR: fenestrated endovascular aortic aneurysm repair.

Visceral and infrarenal aorta: To use these codes, you also have to understand the anatomy of the aorta. The visceral aorta is the area of the upper abdominal aorta containing the celiac, superior mesenteric, and renal arteries. The infrarenal aorta is the abdominal aorta below the kidneys.

More to come: CPT® 2014 did not skimp on the guidelines for these new codes. Future issues of Cardiology Coding Alert will include articles to help you apply the new guidelines to the cases you see.