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Cardiology Coding Alert

Vascular Changes Bring New AAA Repair Codes

Published on Mon Nov 22, 2004

When you read op reports for endovascular repairs, you'll now have to read more closely than before. A slew of 2005 endovascular repair codes - including the new 34803, the deletion of 35161 and 35162, and the additions of a ton of Category III codes - means that you will have to start distinguishing AAA repair codes according to the type of prosthesis.

Look for '2 Docking Limbs' for 34803
 
The new variation, 34803 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [two docking limbs]), describes a prosthesis similar to 34802, but with two, rather than a single, docking limbs, says Gary W. Barone, MD, associate professor of surgery at the University of Arkansas for Medical Sciences in Little Rock.
 
In the operative report, your cardiologist may specify the brand (manufacturer) of the prosthesis, but you should keep in mind that a given manufacturer may have several models. "To simplify, under operative procedure I would state: 'Endograft repair of infrarenal AAA using modular bifurcated endograft with two docking limbs.' " Barone says.
 
Translation: In a nutshell, this means that you'll have to be extra cautious to read documentation to be sure you know exactly which type of prosthesis the cardiologist placed before selecting a code.
 
Deletions: Code 34803 replaces Category III code 0001T, which CPT has deleted for 2005. Other deletions that could impact your practice include:

 

  • 35161 - 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, other arteries

     
  • 35162 - ... for ruptured aneurysm, other arteries.

     Temporary additions: Other temporary Category III endovascular codes effective Jan. 1 include:

     

  • 0078T - Endovascular repair of abdominal aortic aneurysm, pseudoaneurysm or dissection, abdominal aorta involving visceral vessels (superior mesenteric, celiac or renal), using fenestrated modular bifurcated prosthesis (two docking limbs)

     
  • 0080T - ... with radiological S&I

     
  • 0079T - Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch

     
  • 0081T - ... with radiological S&I.

    Just because these codes reach the book Jan. 1 doesn't mean you shouldn't be using them now. "Because Category III codes are new-technology codes, the AMA felt that release of the codes twice a year would help to accumulate data as soon as possible. Having more data will ensure these temporary codes may be converted to Category I CPT codes in a timely fashion," says Melanie Witt, RN, CPC, MA, an independent coding consultant in Fredericksburg, Va.

    93745 Describes WED Set-Up

    You'll have three new codes specific to wearable external defibrillators (WED) to choose from, thanks to CPT 2005. One code describes the initial set-up and programming. You can differentiate the other electronic analysis codes depending on whether the cardiologist does or does not reprogram the wearable external defibrillator:

  • 93745 - Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events
  • 93741 - Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming

  • 93742 - ... ; single chamber or wearable cardioverter-defibrillator system, with reprogramming.

     Note: You should not report 93745 with codes 93741 and 93742, according to CPT.

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