Radiology Coding Alert

Report supervision and interpretation once for road mapping Practical guidance is hard to find when you're coding minimally invasive abdominal aortic aneurysm (AAA). We've got the step-by-step assistance you need to ease your way into coding percutaneous AAA. Advance Your Artery Knowledge Good news: CPT Codes developed specific codes for aneurysm repair. Codes 34800-34900 (plus a few supervision and interpretation and several Category III codes) represent a family of component procedures to report the placement of an endovascular graft for AAA repair. "The real issue is how and when to use them," says Roseanne R. Wholey, president of Roseanne R. Wholey and Associates in Oakmont, Pa.

"One of the keys is to understand the anatomy involved. For example, two-thirds of AAA repairs are not just limited to the aorta but can extend into one or both of the iliac arteries," Wholey says. Another key is that reporting percutaneous AAA requires you to code for associated radiologic S&I, assuming your physician provides and documents image guidance and interpretation services. 1. Expose Your Claim to Surgery Codes When coding AAA, you know the operating physician must first perform an incision. The codes that describe surgical exposure are:

CPT 34812 - Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral

CPT 34820 - Open iliac artery exposure for delivery of endovascular prosthesis
or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral.

34833 - Open iliac artery exposure with creation of conduit for delivery of infrarenal aortic or iliac endovascular prosthesis, by abdominal or retroperitoneal incision, unilateral

34834 - Open brachial artery exposure to assist in the deployment of infrarenal aortic or iliac endovascular prosthesis by arm incision, unilateral. Watch for: Payers include arteriotomy closure in these procedures, so be sure not to code it separately.

2. Place the Catheter Code The two codes you'll use most often to denote catheter placement are 36200 (Introduction of catheter, aorta) and 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity artery branch, within a vascular family), Wholey says.

You may also use a higher-order catheter code based on the puncture site and final position of the catheter, she adds. Bottom line: You'll use at least one catheterization code. Catheter placement is usually bilateral, and you'll need to follow your carriers' guidelines for reporting bilateral placement.

You may report radiologic S&I with endograft device placement codes. Following catheter placement, the physician often performs an angiographic road map. The corresponding radiologic code for this procedure is 75952 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation). Make sure you only report this S&I code once per AAA repair procedure, and note that it also includes [...]