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need second opinion endovascular procedure

  1. #1
    Melbourne, Florida
    Red face need second opinion endovascular procedure
    Medical Coding Books
    This is a big favor..

    If anyone has the time to share their expertise I would be very appreciative. I was advised how to code this two entirely different ways including
    codes that don't appear to match the lower extremities.
    Also the dx: popliteal anuerism (442.3) is not included in the Cardio/Vascular/Thoracic Coding Companion in some of the CPT codes for example 34805 does not allow 442.3.

    This is what I came up with:
    35151-LT (would like to use 34805 to describe the stent but it =abdominal)


    Left SFA/popliteal angiogram and left popliteal stenting with
    endovascular Viabahn covered stent.

    Left popliteal aneurysm.

    Left popliteal aneurysm.

    The patient was prepped and draped in the usual sterile fashion.
    After adequate local anesthesia with 2% Xylocaine, the left femoral
    artery was cannulated with a 4-French sheath. Next, a 6-French
    sheath was exchanged and a Perclose device was then deployed, after
    which, it was exchanged for a 9-French sheath, and then angiogram was
    performed of the left SFA into the popliteal/trifurcation region.
    There appeared to be a large left popliteal aneurysm noted. It was
    then covered with a 9 x 150 Viabahn endovascular covered stent. It
    was then post angioplasties with a 10 mm x ______ mm balloon at both
    the distal and proximal tips. Follow-up angiography showed
    well-deployed stent. The aneurysm had now resolved. It was well
    covered at its origin and at the distal anastomosis site. No
    endovascular leak was noted. After which, the Perclose was used to
    close the common femoral artery with an excellent result. No
    complications were noted.

    1. Left popliteal aneurysm.
    2. Successful stenting with a Viabahn endovascular covered
    stent which was 9 x 150, which successfully covered the entire
    aneurysmal segment.
    3. Final angiogram showed well-apposed stent struts with no
    endovascular leak and excellent/normal flow.
    4. Successfully Perclosed at the termination of the procedure
    without any complications.

    DENISE (studying every night and weekend for the CPC and CCC / CCVTC exams!)

  2. Default
    35151 is used for a direct open repair and 34805 is used for the aorta.
    There is no specific code for a endovascular popliteal aneurysm repair. When a stent graft is used I report 37799 (Unlisted Code).
    34812 is a femoral cut-down which I do not see in the dictation.
    Post dilation of a stent deployment is not reportable.
    Also you only get one cath. placement for this Sx (the furthest cath. placement)
    I would code:

    Michael D. Reyland, CPC, CIRCC
    Surgical Specialists of Georgia

  3. Default need second opinion endovascular procedure

    This is an aneurysm "repair" but the repair is done by placing a transcatheter stent-just my opinion.

    So I would code
    36246 for ipsilateral poplitieal catheterization
    75710-26-59 for diagnostic angiogram
    37205 & 75960-26 for the transcatheter stent placement.

    No angioplasty is reported when done to inflate the stent only.

    Unless I am missing something you should use the transcatheter codes for this procedure. Maybe Michael can explain why he does not use them. I would be interested in knowing as I am not an expert!

    Thank You

  4. #4
    Default Susan G Univ of Md.
    I agree with the codes that Louise chose. I also agree with the 59 modifier on the extremity angiogram as this is diagnostic and will be denied if billed with a therapeutic procedure. You're not coding for a direct repair of a Popliteal aneurysm, rather you are coding for the stent, so when you look at what is being done to repair, you have your answer. I also agree that you would not bill for the angioplasty as this is done to "touch up" the stent to be sure it fits into the vessel. I would be interested in knowing wether or not the unlisted codes is paid for this ?

  5. Default
    According to Medical Asset Management stents are used to open a vessel and improve blood flow. They are not indicated for aneurysm repair and therefore 37205 should not be used. However the Viabahn covered stent is considered to a prosthetic stent and has been indicated for aneurysm repair similar to the AAA stent grafts. Also Medicare pays more for an endovascular aneurysm repair with a stent graft 37799 then 37205.

    Michael D. Reyland, CPC, CIRCC
    Surgical Specialists of Georgia

  6. #6
    Melbourne, Florida
    Thank you all very much for your valued recommendations. Obviously I over coded by not reading the individual codes thoroughly. Mike you mentioned the use of code 37999 (unlisted procedure) pays more than 37205. Can you tell me what is the reimbursement amount for 37999 is measured against?

    Thank you again. I sincerely appreciate the learning experience.

    Denise P.

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