AAPC - Back to school
Results 1 to 2 of 2

Thread: Endovascular aneurysm repair utilizing Zenith graft

  1. #1

    Default Endovascular aneurysm repair utilizing Zenith graft

    AAPC: Back to School
    I am new to cardiovascular coding and have been asked to audit some notes for our vascular surgeon. I would appreciate someone reviewing these notes and clarifying my coding choices. I have also given the codes which were billed by the outside billing company.

    PREOPERATIVE DIAGNOSIS: Enlarging abdominal aortic aneurysm

    POSTOPERATIVE DIAGNOSIS: Enlarging abdominal aortic aneurysm

    OPERATION: Endovascular aneurysm repair utilizing Zenith graft

    ANESTHESIA: General

    FINDINGS: Adequate deployment of endograft without evidence of type 1, 2, 3 or 4 endoleak




    INDICATION FOR PROCEDURE: This is an 83-year-old Caucasian male with an enlarging
    abdominal aortic aneurysm. His anatomy was suitable for endovascular repair. He was
    felt a candidate for the same.

    PROCEDURE AND FINDINGS: Patent was taken to the operating room and placed in the supine
    position. Time out was called, patient positively identified, procedure reviewed. After
    adequate induction of general endotracheal anesthesia, Foley catheter was placed, abdomen
    and groin prepped and draped in sterile fashion. Incision was made above the right
    inguinal crease and extended through subcutaneous tissue. The external iliac and common
    femoral artery were dissected out and circled with vessel loops. Side branches were
    controlled with 0 silk. Lymphatics were ligated as they were encountered. We then
    turned our attempt to the left femoral dissection. Similarly and incision was made above
    the left inguinal crease and extended to subcutaneous tissue. Lymphatics were ligated as
    they were encountered. The external iliac and common femoral arteries were dissected out
    circumferentially. Side branches controlled with vessel loops. Patient was systemically
    heparinized with about 7500 units of heparin. During the course of the procedure ACTs
    were obtained. The first one was less than 200, and the second 2500 units of heparin
    were given. The right femoral artery was cannulated with an introducing needle, a wire
    threaded in retrograde fashion. We had to use the UF catheter and a hydrophilic wire
    because of the tortuosity of the iliac system. We were eventually able to get a wire in
    the suprarenal aorta. We then passed the universal flush catheter in the suprarenal
    aorta following which the glide catheter was removed and a stiff working wire was passed
    without difficulty. The tip of the wire was positioned in the mid thoracic aorta. A
    mark was placed on the back table so we could monitor migration of the wire. An 8 French
    sheath was placed in the right femoral wire prior to placement of the stiff wire. The
    left femoral artery was then cannulated with introducing needle, wire threaded in
    retrograde fashion. A long 8 French sheath was then passed over the wire into the
    aneurysm sac. The UF catheter was then placed in the suprarenal aorta and it was
    connected to the power injector. We then obtained the main body of the device which was
    a TFFB3695ZT. Given the tortuosity of the vessels it appeared as though we needed to
    flip the limbs. Therefore it was positioned appropriately with the contralateral limb
    coming off the right side rather than left side. The 8 French sheath was then removed
    from the right femoral access site. The delivery system for the main body was placed
    over the stiff working wire. A transverse arteriotomy was made with the 11 blade as we
    placed it into the artery so that we had a controlled arteriotomy. Under fluoroscopic
    guidance we were then able to pass the delivery system to the level of the lowest renal
    artery. The lowest renal artery was the left. The graft was then deployed to the
    position of the contralateral gate exposure. We were satisfied with the location after
    two subsequent angiograms and the suprarenal struts were then positioned. Prior to doing
    this the UF catheter was withdrawn into the distal aortic sac. We were then able to
    cannulate the contralateral limb with moderate difficulty. UF catheter was placed into
    the aneurysm sac and utilizing the spin technique we were able to document that we were
    within the graft. A stiff working wire was then passed through this catheter and
    positioned appropriately in the mid descending thoracic aorta. Again, it was monitored
    on the back table for position. We then obtained the contralateral limb TFLE20-73ZT.
    Retrograde angiogram was performed in the RAO projection with splayed out the iliac
    bifurcation nodularly allowing us to determine our landing zone. The limb was then
    passed over the wire, positioned appropriately and deployed without difficulty. The
    ipsilateral limb was then fully deployed following which we captured the cone and
    withdrew it. Retrograde angiogram was then performed through the sheath in the usual
    fashion again displaying the ipsilateral bifurcation nicely. We then obtained the
    ipsilateral limb TFLE2056ZT. It was passed over the wire and deployed without
    difficulty. It landed just above the iliac bifurcatio. A coated balloon was then
    obtained and inflated it in all sealed areas proximally, the body of the graft, and
    throughout both limbs of the graft. It was then withdrawn. Completion angiogram showed
    no type 1, 2, 3, or 4 endoleak. Both internal iliacs remained patent. All catheters and
    wires were then removed and the vessels clamps. The arteriotomies were closed in
    transverse fashion with interrupted 5-0 Prolene. Prior to completing the anastomosis the
    vessels were forward bled, back bled, and suctioned out. Flow as then established
    distally. Good pulses and Doppler signals were noted. 25 mg of Protamine was given for
    partial reversal of the heparin. Wounds were irrigated with copious amounts of
    antibiotic solution. Gelfoam and Thrombin were placed in anastomotic site. Wound then
    closed in multiple layers of running 2-0 and 3-0 Vicryl suture. Skin was approximated
    with skin clips. Both femoral incisions were blocked with 0.5% Marcaine. Patient
    tolerated the procedure well.

    Billed codes -- 34803, 34812, 35226, 36200, 75952

    My code choices -- 34803, 34812 - 51,50, 75952-26

  2. #2
    Join Date
    Apr 2007
    Central Indiana

    Exclamation Endo AAA Repair

    Here's the correct answers:

    34812-50 (51 isn't required because this is component coding)

    I disagree that the billing company coded for an artery repair. This is only reported if "extensive repair or replacement of artery" is required. The surgeon can't bill for an arteriotomy they created to perform the AAA repair.

    You missed the catheterization codes and the billing company only billed for one. Depending on the carrier, some prefer 36200-50. From a coding standpoint, it is more appropriate and correct to bill it twice with the second having a 59 modifier.

    The introductory paragraphs for endo repair of AAA is very well laid out in the CPT book. Use it as a guide until you become more familiar with what is reportable and what isn't.

    Hope this helps and good luck! There's nothing more challenging than vascular coding!!

    Keri H, CIRCC

Similar Threads

  1. Endovascular Abdominal Aortic Aneurysm Repair
    By klthompson in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 02-05-2013, 10:10 AM
  2. Endovascular carotid aneurysm repair
    By Nikole_D in forum Cardiovascular Thoracic
    Replies: 2
    Last Post: 01-22-2013, 02:12 PM
  3. Open and endovascular aortic aneurysm repair
    By conleyclan in forum Cardiovascular Thoracic
    Replies: 0
    Last Post: 07-10-2012, 10:52 AM
  4. Repair aneurysm of CABG graft
    By MON1555 in forum Cardiovascular Thoracic
    Replies: 1
    Last Post: 05-03-2012, 03:15 PM
  5. Endovascular repair popliteal aneurysm
    By elkecranfill in forum Cardiology
    Replies: 1
    Last Post: 01-03-2009, 12:11 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.