EVAR with renal stent

Robbin109

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Pt had a typical Aortic-bi-iliac Endograft placed (34705) then angiogram showed Type 1 endoleak.
Then 6 EndoAnchors were deployed ( 34712).
Repeat angio still showed Type I endoleak. At this point, he marked the renal artery and deployed a 34x34x52 cuff creating them 2 to 3 mm above the prior graft and deployed the top cap with the suprarenal stents.
Repeat angio showed partial encroachment on the left renal artery. This was stented with 7mm x 27mm balloon expandable stent.

Are these two procedures coded with 34709 for cuff and 37236 for renal stent.

Or is the renal stent considered in the treatment zone and not reported. And is that a true extension that can be billed (34709)?


Additional, when he went to remove the sheaths, the vessel began to bleed and a emergent groin incision was made and dissection carried down to the femoral artery and hematoma was evacuated and artery was repaired with suture. I believe this is not coded since it seems he caused this?

If you can answer any part of this that would be appreciated.

Thank you!!
 
Last edited:

mk2001

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Pt had a typical Aortic-bi-iliac Endograft placed (34705) then angiogram showed Type 1 endoleak.
Then 6 EndoAnchors were deployed ( 34712).
Repeat angio still showed Type I endoleak. At this point, he marked the renal artery and deployed a 34x34x52 cuff creating them 2 to 3 mm above the prior graft and deployed the top cap with the suprarenal stents.
Repeat angio showed partial encroachment on the left renal artery. This was stented with 7mm x 27mm balloon expandable stent.

Are these two procedures coded with 34709 for cuff and 37236 for renal stent.

Or is the renal stent considered in the treatment zone and not reported. And is that a true extension that can be billed (34709)?


Additional, when he went to remove the sheaths, the vessel began to bleed and a emergent groin incision was made and dissection carried down to the femoral artery and hematoma was evacuated and artery was repaired with suture. I believe this is not coded since it seems he caused this?

If you can answer any part of this that would be appreciated.

Thank you!!
I wouldn't think you could bill the extension code even though he says partial encroachment on the left renal. I think it would still be included as the treatment zone. I don't see why you couldn't bill the 37236 for the renal stent though.
 

suchang78

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34705- target zone is below the renal arteries in the aorta and 2 common iliac arteries.
34709 - the extension must be terminated either in the internal iliac, external iliac, or common femoral arteries or be placed in the abdominal aorta above the renal arteries(suprarenal aorta)
 

Robbin109

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Yes, he placed the extension in the abd aorta above the renal arteries. It then encroached on the renal artery and a stent was placed. The renal stent code would be included?
 

mk2001

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It would definitely be an extension if it was placed above the renal arteries. Sorry. I thought he placed the cuff below the renal arteries which we do 99% of the time.
 
Last edited:

suchang78

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Yes, he placed the extension in the abd aorta above the renal arteries. It then encroached on the renal artery and a stent was placed. The renal stent code would be included?
If there is no documentation to indicate why placed the stent into left renal arteries, other than because the endograft was placed. I wont code it.
 
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