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Help - just don't know what to code!!!

  1. Angry Help - just don't know what to code!!!
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    My doc is doing 33860-ascending aoarta graft for ascending aorta aneurysm and 33870-transverse arch graft because the aneurysm extends into the aortic arch. The chest is wide open doing these procedures. He is also doing a descending thoracic graft for dissection. He wants me to code 33880-endovascular repair of descending thoracic aorta. He uses a 3700 Tag Gore-Tex endograft and is placed across the anastomosis into the thoracic aorta. This endograft is anastomosed to the ascending and arch graft previously placed.

    This is how I understand 33880, an open approach can be done to get to the vessel, but then wires and sheaths are passed thru the vessel, angiography is done to find the target area and the graft is deployed from within a device at the target area. I think this is done looking at a monitor via the angiography....am I right? This op does not say anything about catheters being threaded in, angiography (I code heart caths and peripheral angioplasties and stents, so I know how this works). I don't like code 33880 and think it should be 33875, but he insists that this endograft is deployed but the chest is wide open. I'm confused, maybe I am not understanding endovascular codes correctly, but I can't find any different explanation other than my CDR. PLEASE HELP! Please explain an endovascular repair.

    Deb
    Frustrated

  2. #2
    Location
    Richardson, TX
    Posts
    822
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    Quote Originally Posted by hencked View Post
    My doc is doing 33860-ascending aoarta graft for ascending aorta aneurysm and 33870-transverse arch graft because the aneurysm extends into the aortic arch. The chest is wide open doing these procedures. He is also doing a descending thoracic graft for dissection. He wants me to code 33880-endovascular repair of descending thoracic aorta. He uses a 3700 Tag Gore-Tex endograft and is placed across the anastomosis into the thoracic aorta. This endograft is anastomosed to the ascending and arch graft previously placed.

    This is how I understand 33880, an open approach can be done to get to the vessel, but then wires and sheaths are passed thru the vessel, angiography is done to find the target area and the graft is deployed from within a device at the target area. I think this is done looking at a monitor via the angiography....am I right? This op does not say anything about catheters being threaded in, angiography (I code heart caths and peripheral angioplasties and stents, so I know how this works). I don't like code 33880 and think it should be 33875, but he insists that this endograft is deployed but the chest is wide open. I'm confused, maybe I am not understanding endovascular codes correctly, but I can't find any different explanation other than my CDR. PLEASE HELP! Please explain an endovascular repair.

    Deb
    Frustrated
    Can you post the OP note? That would be helpful. I do agree that 33875 is an OPEN approach with direct repair and 33880 would deploy the endograft via catheter. If he is insistant that you code 33880 then maybe talk to him about his dictation so that you can understand what he did for the next time. I know sometimes physicians have a way of saying things in their dication, confusing us, the coder but they know exactly what it means. Did you explain to him your concern over not seeing any mention of cathethers but seeing an open approach?
    Julie Graham, BA, CPC, CCC

  3. #3
    Location
    Richardson, TX
    Posts
    822
    Default
    Quote Originally Posted by hencked View Post
    My doc is doing 33860-ascending aoarta graft for ascending aorta aneurysm and 33870-transverse arch graft because the aneurysm extends into the aortic arch. The chest is wide open doing these procedures. He is also doing a descending thoracic graft for dissection. He wants me to code 33880-endovascular repair of descending thoracic aorta. He uses a 3700 Tag Gore-Tex endograft and is placed across the anastomosis into the thoracic aorta. This endograft is anastomosed to the ascending and arch graft previously placed.

    This is how I understand 33880, an open approach can be done to get to the vessel, but then wires and sheaths are passed thru the vessel, angiography is done to find the target area and the graft is deployed from within a device at the target area. I think this is done looking at a monitor via the angiography....am I right? This op does not say anything about catheters being threaded in, angiography (I code heart caths and peripheral angioplasties and stents, so I know how this works). I don't like code 33880 and think it should be 33875, but he insists that this endograft is deployed but the chest is wide open. I'm confused, maybe I am not understanding endovascular codes correctly, but I can't find any different explanation other than my CDR. PLEASE HELP! Please explain an endovascular repair.

    Deb
    Frustrated
    Did you mean 33880 or 33860? I might not be following correctly. I think I also see this op note on another thread. I'm going to read it..
    Julie Graham, BA, CPC, CCC

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