Arterial Cut-Downs during EVAR

RhondaJohnson

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What is the appropriate way to bill in EVAR repairs in which a general surgeon performs the arterial exposure and then an interventional radiologist places the endograft? The general surgeon is only involved in the artery exposure and repair, they do not assist or participate in the placement of the endograft prosthesis.

34812 is an add-on code. You can't bill just an add-on code to the general surgeon can you? Or is this considered a co-surgery because the general surgeon does the exposure and the IR provider places the graft? Modifier -62 on the 34705?

Thanks for any help you can offer.

Rhonda Johnson, CPC
 

ernist8489

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Hey there I am Erik Brown, CIRCC, CPC.
The Guidelines for modifier 62 state as follows- For the procedures performed as co-surgery both co-surgeons are expected to bill the exact same combination of procedure codes with modifier 62 appended. Additional procedures performed in the same operative session mayh be reported as either primary surgeon or assistant surgeon.
Example:
Interventional ﹰRadiologist
34705-62, (+)34812-62
General Surgeon
34705-62, (+)34812-62


If you ever need help woith IR, CVIR, Vascular/ENDOVASCULAR, Cardiology, Cardiovascular Thoracic, OB, Vascular Neurointerventional etc email me directly at
 

RhondaJohnson

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What if the general surgeon performs absolutely no part of the 34705? To bill a co-surgery two surgeons perform distinct parts of a surgery represented by ONE code. In the cases I'm talking about the general surgeon performs the cut-down and then the interventionalist does all the work of the 34705. In some cases the general surgeon leaves the operative suite after performing the cut-down. How do you append a co-surgery modifier to a cpt code that a surgeon wasn't even present for?
 

mrsalexander

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Cumberland, MD
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Hi Rhonda (or anyone else who can help a girl out) - Did you ever get an answer for this issue? I have the same problem with cardiovascular surgeon doing the cut-down and interventional radiologist performing the repair. CV surgeon only does the cut-down, IR only does the repair, is it still ok to use mod 62? I've read the CMS references but that does not address this situation. Has anyone ever ran across articles on this?
 

mk2001

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Hi Rhonda (or anyone else who can help a girl out) - Did you ever get an answer for this issue? I have the same problem with cardiovascular surgeon doing the cut-down and interventional radiologist performing the repair. CV surgeon only does the cut-down, IR only does the repair, is it still ok to use mod 62? I've read the CMS references but that does not address this situation. Has anyone ever ran across articles on this?
I have still used the 62 modifier for our cardiovascular surgeons due to this example from my Revenue Cycle Coding Strategies Navigator for Interventional Radiology/Procedures book.

Example: Endovascular repair is performed for an unruptured infrarenal aortic aneurysm using an aorto-uni-iliac endoprosthesis. Access is by open exposure of the bilateral femoral arteries. The physician places an occlusion device in the right common iliac artery and performs a left femoral to right femoral bypass.

Codes: 34703, 34812 x 2, 34808, 34813

Reasoning: The repair is reported with code 34703, and the bilateral femoral artery exposure is reported with 2 units of code 34812. The iliac artery occlusion device placement is reported with code 34808 and the femoral-femoral bypass is reported with 34813. Note that the arterial exposure and bypass are typically performed by a vascular surgeon. If an interventional radiologist serves as co-surgeon for this procedure, the radiologist would report 34703-62 and 34808-62 and the vascular surgeon would report 34703-62, 34812 x 2, 34808-62 and 34813.
 
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