Radiology Coding Alert

Hint:  Match the new RS&I and surgery codes

Don't be fooled by the new codes for endovascular repair of the descending thoracic aorta. The procedures may be similar to AAA repair, but you have a new set of rules to master, such as knowing whether you can code for distal extensions.

CPT Codes 2006 replaced category III codes 0033T-0037T with endovascular repair codes 33880-33889. CPT also swapped category III codes 0038T-0040T for radiology supervision and interpretation (RS&I) codes 75956-75959.
 
A change from category III codes is always welcome, says Marylin Brinkman, CPC, radiology coding specialist for Clarian Health in Indiana. Dedicated CPT I codes tend to make coding and receiving reimbursement easier.

CPT 2006 also added code 33891 to cover specific surgical bypass procedures performed in conjunction with endovascular repair of the descending thoracic aorta. Decipher Code Changes to Avoid Denials Apply the new codes when your physician repairs the descending thoracic aorta using an endovascular graft and/or supplies radiological supervision and interpretation.
 
These procedures are similar to the ones doctors have been performing for years to treat abdominal aortic aneurysm (AAA). "The key difference is that the anatomic area being treated is in the thoracic aorta--the portion of aorta between the abdominal aorta and the aortic arch," says Jim Collins, ACS-CA, CHCC, CPC, a coding consultant in Matthews, N.C.  

These codes differ from the existing AAA extension graft codes (34825-34826). For the new codes, you should separately code each graft your physician deploys rather than "each vessel" as you do with the AAA codes, Collins says.

Distal extensions: Unlike the traditional AAA repair codes, these endovascular thoracic repair codes include any distal extensions deployed at the time of the procedure to the celiac artery level.
 
Example: A patient undergoes endovascular repair of a descending thoracic aortic aneurysm with coverage of the left subclavian origin. The physician places two distal extensions.
 
What to do: Report one unit of 33880 (Endovascular repair of descending thoracic aorta [e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption]; involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension[s], if required, to level of celiac artery origin), says Jackie Miller, RHIA, CPC, senior consultant for Coding Strategies Inc. in Powder Springs, Ga. Don't report codes for the placement of the distal extensions, because that is included in 33880, she adds.  Remember: You should watch for other separately reportable procedures, Miller says.

Proximal extensions: If your physician uses proximal extensions at the time of the initial graft deployment, you should report them separately with these new codes:

• 33883--Placement of proximal extension prosthesis for endovascular repair of  descending thoracic aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); initial extension

• +33884--...each additional proximal extension [...]