EVAR for pseudoaneurysm in aortofemoral vein graft

Misty Dawn

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I am so lost on what to code for this report. I am thinking 37236? Please help!

Selective right aorto-femoral graft angiogram
Endovascular graft placement within the right aortofemoral CryoVein graft - Viabahn 13.0 mm x 10 cm self-expanding covered graft


Operators:
Dr. A

Dr. B




  1. [*=2]Right aortofemoral graft access. Right aortofemoral graft access was obtained via surgical cutdown by Dr. B. Next an 11 French sheath was placed.



  1. [*=2]Selective right aortofemoral graft angiogram. Next a glide catheter was advanced over the wire to the proximal right aortofemoral graft and baseline angiogram was performed. This revealed large pseudoaneurysm of the distal aspect of the graft.



  1. [*=2]Endovascular graft placement within the right aortofemoral CryoVein graft. Next an Amplatz extra stiff wire was placed through the glide catheter and the glide catheter was removed. Next a Viabahn 13.0 mm x 10 cm self-expanding covered graft was advanced to the appropriate location and deployed. Next the Viabahn graft was postdilated with 12.0 mm charger balloon. Final angiogram revealed no residual pseudoaneurysm and no evidence of dissection, perforation or flow limitation. Next the catheter was removed and the 11 French sheath was removed and hemostasis obtained. Surgical cutdown was then closed.

Findings:

Large pseudoaneurysm of the distal aspect of the right aortofemoral CryoVein graft

Conclusions

Successful closure of pseudoaneurysm of right aortofemoral graft with Viabahn 13.0 x 10 cm self-expanding covered endoprosthesis
 

Jim Pawloski

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I am so lost on what to code for this report. I am thinking 37236? Please help!

Selective right aorto-femoral graft angiogram
Endovascular graft placement within the right aortofemoral CryoVein graft - Viabahn 13.0 mm x 10 cm self-expanding covered graft


Operators:
Dr. A

Dr. B




  1. [*=2]Right aortofemoral graft access. Right aortofemoral graft access was obtained via surgical cutdown by Dr. B. Next an 11 French sheath was placed.



  1. [*=2]Selective right aortofemoral graft angiogram. Next a glide catheter was advanced over the wire to the proximal right aortofemoral graft and baseline angiogram was performed. This revealed large pseudoaneurysm of the distal aspect of the graft.



  1. [*=2]Endovascular graft placement within the right aortofemoral CryoVein graft. Next an Amplatz extra stiff wire was placed through the glide catheter and the glide catheter was removed. Next a Viabahn 13.0 mm x 10 cm self-expanding covered graft was advanced to the appropriate location and deployed. Next the Viabahn graft was postdilated with 12.0 mm charger balloon. Final angiogram revealed no residual pseudoaneurysm and no evidence of dissection, perforation or flow limitation. Next the catheter was removed and the 11 French sheath was removed and hemostasis obtained. Surgical cutdown was then closed.

Findings:

Large pseudoaneurysm of the distal aspect of the right aortofemoral CryoVein graft

Conclusions

Successful closure of pseudoaneurysm of right aortofemoral graft with Viabahn 13.0 x 10 cm self-expanding covered endoprosthesis
I would code 37226 since the aneurysm is in the femoral zone. 37236 is for non-lower extremity intervention.
HTH,
Jim Pawloski, CIRCC
 

Misty Dawn

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37236 can be used in lower extremity unless treating occlusive "[FONT=&quot](except lower extremity artery(s) for occlusive disease..." cpt 2017[/FONT]
 

ldhcoder

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37236 can be used in lower extremity unless treating occlusive "[FONT=&quot](except lower extremity artery(s) for occlusive disease..." cpt 2017[/FONT]
Did you ever get a response on this? Novitas is denying our claim and stated that we billed the wrong CPT of 37236 but we are placing the stent for an pseudoaneurysm not treating occlusive. They state that they are aware they have no LCD for aneurysm but insist that we are billing incorrectly.
 
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