Coding guidelinesCurrent Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) operations. This information does not override NCCI operations. Consult NCCI for proper coding guidelines and specific applicable code combinations prior to billing Medicare.
Endovascular repair of aortic aneurysms requires the combined effort of radiologists and vascular surgeons. These procedures have several main components:
- Preservice planning a dimensioning
- Treatment zone defined
- Open exposure of the artery to allow placement of the endovascular graft
- Report bilateral aneurysm repair
- Introduction of guidewires and catheters
- Imaging in conjunction with endovascular repair
- Placement of the prosthesis
- Report extensions
- Endovascular repair with rupture or other than rupture repair
Preservice planning a dimensioning
Preprocedure sizing of the aneurysm and selection of the appropriate endograft type are part of the preservice work included in endograft CPT codes 34701-34708. The preservice planning and dimensioning need not be reported separately.
Treatment zone defined
The CPT manual defines the treatment zone as the vessels into which an endograft(s), including the main body, attached limb(s) and/or extension(s), is deployed during a operative session. For reporting purposes, the treatment zone for endovascular repair of abdominal aorta and/or iliac arteries extends the entire length of the treated vessel, even if the device used does not cover the entire vessel.
Services included in the endovascular repair codes include angioplasty and stenting performed within the treatment zone, placement and fixation of endografts, placement of extensions in the aorta from the renal arteries to the iliac bifurcation, non-selective catheterization, and radiological supervision and interpretation. These services do not have to be reported separately.
Exposure of the artery
Open arterial exposure is performed during endovascular repair of abdominal aorta and/or iliac arterial procedures when a vessel is too small in diameter to accommodate the endograft. As of 2018, open exposure codes are add-on codes. Use additional CPT codes 34812, 34820, 34833, 34834, 34714, 34715, or 34716 to report open artery exposure, depending on the artery used. When the same open arterial exposure is used bilaterally, report the additional open exposure code twice with the appropriate anatomical modification.
When reporting surgical exposure of the artery by the same physician who performed the primary endovascular repair of the aortic aneurysm, use the CPT code specific to the artery (e.g.,
If an extensive repair or replacement of the exposed artery is required, it must be billed with CPT code 35266 or 35286.
Report bilateral aneurysm repair
Report concurrent bilateral iliac aneurysm repairs with aorto-bi-iliac endograft with CPT code 34705 or 34706.
If treating bilateral iliac artery aneurysms, report with CPT code 34707 or 34708 with -50 modifier.
Introduction of guidewires and catheters
Non-selective catheterization is inherent to CPT codes 34701-34708 and is not separately reportable. Selective catheterization of the hypogastric artery(s), renal artery(s) and/or arterial families outside the endograft treatment zone may be reported separately.
Selective insertion of a catheter should be reported using the appropriate catheterization codes as follows:
- Use CPT codes 36140, 36200-36218, if applicable, for repair of a descending chest aneurysm.
- For repair of an abdominal aortic aneurysm, use CPT codes 36200, 36245-36248, and 36140, as appropriate.
As above, when reporting catheterization by the same physician who performed the AAA endovascular repair, add the -51 modifier to the appropriate catheterization code.
Imaging in conjunction with endovascular repair
As of 2018, separate CPT codes for monitoring and interpretation of endograft services have been dropped. Most imaging services related to endovascular repair codes are included in the new endograft codes. Services that cannot be reported separately with 34701-34708 include the following, please note this list may not be all inclusive:
- Radiological monitoring and interpretation,
- Intraprocedural and completion angiography (e.g., confirm position, detect endoleak, etc.),
- All intraprocedural imaging (e.g., angiography, CT rotation, etc.) of the aorta and its branches prior to deployment of the endovascular device, and
- Fluoroscopic guidance and mapping used to deliver endovascular components.
Use CPT codes 75956-75959, if applicable, for repair of a descending thoracic region aneurysm.
Placement of the prosthesis
Different codes may be used when repairing an aneurysm of the abdominal aorta and/or iliac artery. Use CPT codes 34701, 34702, 34703, 34704, 34705, 34706, 34707, or 34708 for repair of an abdominal aortic/iliac aneurysm (with or without rupture) with an endovascular graft.
CPT code 34717 and 34718 describe endovascular repair of the iliac artery using an iliac bifurcated endograft. CPT 34717 is an additional code and is reported in conjunction with CPT codes 34703, 34704, 34705, or 34706. CPT 34718 is a standalone code and should not be reported with 34703, 34704, 34705, or 34706.
Code 34717 may only be reported once per side. Report 34717 twice in bilateral procedures. Do not report modifier 50 in combination with 34717.
Code 34718 - for bilateral placement of an iliac bifurcated endograft, report modifier 50.
Use CPT codes 33880-33891 for replacement of the thoracic branch aneurysm with an endovascular graft.
If an iliac artery occlusion device is required, CPT code 34808 may apply when performed in the same surgical setting as the endovascular repair.
CPT code 34813 is used when a femoral-femoral prosthetic graft is required during endovascular repair of the abdominal aortic aneurysm.
When the abdominal aortic aneurysm cannot be repaired by an endovascular approach and an open approach must be used to complete the procedure, use CPT codes 34830, 34831, or 34832.
Report extensions
Reporting extensions depends on the procedure performed and not on the specific device installed. CPT Code 34709 is an additional code to CPT Codes 34701-34708 and is reported once per ship handled, regardless of the number of expansion modules required to complete the procedure. Extension prosthesis(s) may not be reported separately when placed in the treatment area. Linked limbs are considered part of the endograft procedure and are not reported separately, even when the docked leg used to complete the procedure extends into the external iliac artery. Otherwise, CPT Code 34709 must be reported once per vessel when prosthesis extension(s) is required in any of the following cases:
- Above the renal arteries (CPT codes 34701, 34702)
- Above the renal arteries or below the iliac branch(s) (CPT codes 34703, 34704, 34705, 34706)
- Below the iliac bifurcation (CPT codes 34707, 34708)
CPT codes 34710 and 34711 are used for delayed placement of the extension prosthesis(s) that is not performed during the same surgical session as CPT codes 34701-34709.
Endovascular repair with rupture or other than ruptureEndovascular repair in the aortic or iliac arteries for acute rupture is reported using CPT codes 34702, 34704, 34706, or 34708. When reporting these codes, rupture is defined in the CPT manual as "clinical and/or radiographic evidence of acute hemorrhage". Trapped/stable ruptures or chronic ruptures (also called pseudoaneurysms) are repaired with CPT codes 34701, 34703, 34705, or 34707.
Other Billing ConsiderationsOther interventional procedures performed at the time of endovascular repair of the abdominal aortic aneurysm may be additionally reported (e.g., renal transluminal angioplasty, arterial embolization, intravascular ultrasound, balloon angioplasty of native artery[s] outside the graft [e.g., aorta or iliac] before and after deployment of the endoprosthesis). The treatment zone encompasses the entire vessel being treated, even if the device does not cover the entire vessel. Any stent placed in the endograft treatment zone before, during, or after endograft placement is included in the endograft placement. There are; however, indications for placement of individual vascular stents outside the endograft treatment zone (e.g., iliac, renal arteries). These stent placements should be coded with CPT codes 37236-37239. Note: CPT codes 37236-32739 include radiological monitoring and interpretation.Endovascular repair codes should not be used for the treatment of atherosclerotic occlusive disease in the iliac artery(s).
When AAA endovascular repair is performed by collaborating physicians, each participant must report the appropriate repair codes and add modifier -62 (fellow surgeons) or modifier -80 (assistant surgeon).
For example, in situations where a cardiologist bills for the supervision (the "S") of the S&I code, and a radiologist bills for the interpretation (the "I") of the code, both physicians should use a -52 modifier indicating a reduced service, for example only the interpretation. When a -52 modifier is reported, Novitas recommends that you include supporting documentation or explanations when submitting the claim. For more information on how to use modifier -52, see our website at Novitas-solutions.com.
FAQs
How do you code an endovascular aneurysm repair? ›
Endovascular repair in the aortic or iliac arteries for acute rupture is reported using CPT codes 34702, 34704, 34706, or 34708.
What is the CPT code for iliac artery aneurysm repair? ›CPT® 34705, Under Endovascular Repair Procedures of the Abdominal Aorta and/or Iliac Arteries. The Current Procedural Terminology (CPT®) code 34705 as maintained by American Medical Association, is a medical procedural code under the range - Endovascular Repair Procedures of the Abdominal Aorta and/or Iliac Arteries.
What is the ICD-10 code for endovascular aortic aneurysm repair? ›Z95. 828 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
What is endovascular repair of Abdominal Aorta and or Iliac Arteries? ›Endovascular aneurysm repair (EVAR) is an important advance in the treatment of abdominal aortic aneurysm (AAA). EVAR is performed by inserting graft components that are folded and compressed within a delivery sheath through the lumen of an access vessel, usually the common femoral artery.
What is the CPT code for endovascular embolization? ›CPT® Code 37243 - Vascular Embolization and Occlusion Procedures on Arteries and Veins - Codify by AAPC.
What is the criteria for endovascular AAA repair? ›- The AAA diameter is greater than 5.5 cm in diameter in men. ...
- The patient with AAA is symptomatic[3]
- The AAA is rapidly expanding (more than 1 cm/year) irrespective of the absolute diameter.
ICD-10 Code for Aneurysm of iliac artery- I72. 3- Codify by AAPC.
What is the ICD-10 code for aortic and iliac aneurysm? ›ICD-10 code: I72. 3 Aneurysm and dissection of iliac artery.
What is the CPT code for embolization of internal iliac artery? ›37242 can be used when non-target vessel embolization of an inferior mesenteric artery (IMA), internal iliac, or accessory renal is reported at the same session as an endovascular aneurysm repair (EVAR) or iliac aneurysm endograft repair.
What is the ICD-9 for endovascular aneurysm repair? ›| Endovascular aneurysm repair | |
|---|---|
| Endovascular aneurysm repair | |
| Other names | Endovascular aortic repair |
| ICD-9-CM | 39.51, 39.52, 39.7 |
What is endovascular aneurysm repair for AAA? ›
Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation.
What is endovascular repair of aneurysms? ›With endovascular aneurysm repair (EVAR), surgeons can repair an aneurysm without an open incision. Increasingly, Penn surgeons can use this minimally invasive technique for many types of aneurysms. Compared to open surgery, EVAR has less pain, improved outcomes and faster healing.
What is an aneurysm of the abdominal aorta or iliac arteries? ›An iliac aneurysm is bulging and weakness in the wall of the iliac artery, a group of arteries located in the pelvis. Iliac aneurysms can burst, which can cause life-threatening, uncontrolled bleeding. Causes of iliac aneurysms include: Atherosclerosis.
What is aortic or iliac aneurysm? ›What is an iliac aneurysm? An iliac aneurysm is bulging and weakness in the wall of one of the iliac arteries. The common iliac arteries branch off the abdominal aorta in the pelvic area. These arteries further branch into internal iliac arteries and external iliac arteries.
Is the iliac artery part of the abdominal aorta? ›The common iliac artery branches off from the bottom part of the abdominal aorta (the largest blood vessel in the abdomen) into the right common iliac artery and left common iliac artery.
What is the difference between CPT code 37241 and 37242? ›You can see from the code definitions that you'll choose 37241 for venous embolization/occlusion other than for hemorrhage, and 37242 for arterial embolization/occlusion other than for hemorrhage.
What is the CPT code for AAA coil embolization? ›CPT® 37242, Under Vascular Embolization and Occlusion Procedures on Arteries and Veins. The Current Procedural Terminology (CPT®) code 37242 as maintained by American Medical Association, is a medical procedural code under the range - Vascular Embolization and Occlusion Procedures on Arteries and Veins.
What is the CPT code for aneurysm embolization? ›75894—Transcatheter therapy, embolization, any method, radiological supervision and interpretation. 75898—Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis.
How is an open abdominal aortic aneurysm surgery different from an endovascular aneurysm repair? ›Elective endovascular repair of an abdominal aortic aneurysm results in lower perioperative mortality than traditional open repair, but after 4 years this survival advantage is not seen; in addition, results of two European trials have shown worse long-term outcomes with endovascular repair than with open repair.
What is endovascular surgery for ascending aortic aneurysm? ›Endovascular means that surgery is performed inside your aorta using thin, long tubes called catheters. Through small incisions in the groin, the catheters are used to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm.
What is endovascular repair of abdominal aortic aneurysm with stent? ›
Endovascular stent grafting, or endovascular aneurysm repair (EVAR), is a newer form of treatment for abdominal aortic aneurysm that is less invasive than open surgery. Endovascular stent grafting uses an endovascular stent graft to reinforce the wall of the aorta and to help keep the damaged area from rupturing.
What does an endovascular repair of an iliac aneurysm include? ›Conventional endovascular treatment includes coil embolization of the internal iliac artery (IIA), followed by extension of the main bifurcated AAA stent-graft into the external iliac artery.
What is iliac artery aneurysm ICD-9? ›442.2 Iliac artery aneurysm - ICD-9-CM Vol. 1 Diagnostic Codes.
What is the ICD-10 code for aneurysm surgery? ›ICD-10 Code for Aneurysm of unspecified site- I72. 9- Codify by AAPC.
What is the ICD-10 code for aortic aneurysm surgery? ›ICD-10-CM Code for Aortic aneurysm and dissection I71.
What is the ICD-10 code for AAA aneurysm? ›Abdominal aortic aneurysm, without rupture
ICD-10-CM I71. 4 is a new 2023 ICD-10-CM code that became effective on October 1, 2022.
ICD-10 Code for Abdominal aortic aneurysm, without rupture- I71. 4- Codify by AAPC.
What is the ICD-10 code for embolization of right internal iliac artery? ›ICD-10 code I74. 5 for Embolism and thrombosis of iliac artery is a medical classification as listed by WHO under the range - Diseases of the circulatory system .
What is iliac artery embolization? ›Objectives: Internal iliac artery (IIA) coil embolization as an adjunct to endovascular stent grafting (ESG) is common practice for treating abdominal aortic aneurysm (AAA) in patients with a substantially enlarged common iliac artery requiring extension of the stent-graft limb into the external iliac artery.
What is the CPT code for angioplasty and stent iliac artery? ›There are CPT codes to describe iliac atherectomy services. If performed percutaneously, codes 35492 and 75992 can be used to report the services.
What is the ICD-9 code for endovascular aortic repair? ›
Among those without procedure codes for open aortic surgery, those with an ICD-9 procedure code for endovascular stent graft repair (39.73, 39.79) are stratified as treated with TEVAR.
What is endovascular embolization ICD-9? ›Endovascular embolization or occlusion of vessel(s) of head or neck using bare coils ICD-9-CM Vol 3 Code 39.75.
What is the ICD-10 for endovascular graft? ›ICD-10 code Z95. 828 for Presence of other vascular implants and grafts is a medical classification as listed by WHO under the range - Factors influencing health status and contact with health services .
Is the acronym EVAR endovascular aortic repair? ›Endovascular aortic repair (EVAR) is a minimally invasive procedure used to repair aortic aneurysms and dissections that occur in the abdominal aorta.
What is the CPT code for endovascular repair of abdominal aortic aneurysm? ›CPT® Code 34808 - Endovascular Repair Procedures of the Abdominal Aorta and/or Iliac Arteries - Codify by AAPC.
What is the medical term for aortic aneurysm repair? ›AAA - open; Repair - aortic aneurysm - open. Open abdominal aortic aneurysm (AAA) repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood from your heart to your belly (abdomen), pelvis, and legs.
What are the two types of aneurysm repair? ›There are two types of surgery: endovascular surgery, which is minimally invasive, and open surgery, which uses a larger incision. The type of surgery doctors choose depends on many factors, including the location of the aneurysm and its size. Your health is also a factor in the decision.
What is the difference between vascular and endovascular? ›Vascular surgery and endovascular surgery are both modalities to treat vascular disease. Endovascular describes a minimally invasive approach commonly done through needle puncture and a sheath. Traditional vascular surgery is more invasive and involves incisions, which is more surgical in nature.
When should an iliac artery aneurysm be repaired? ›Isolated iliac artery aneurysms can rupture, embolize, or produce local compression symptoms. The rate of rupture increases significantly between 3 and 4 cm, and therefore most surgeons recommend operative repair for iliac aneurysms larger than 3.0 to 3.5 cm in diameter.
What is the difference between an abdominal aneurysm and an abdominal aortic aneurysm? ›While an aneurysm may occur in any blood vessel, but is most often seen in an artery, an abdominal aortic aneurysm (AAA) occurs in the wall of the aorta (the largest artery in the body) within the abdomen.
What is the difference between an aneurysm and an aortic aneurysm? ›
An aneurysm can develop in any artery. An aortic aneurysm develops when there's a weakness in the wall of your aorta. The pressure of blood pumping through the artery causes a balloon-like bulge in the weak area of your aorta. This bulge is called an aortic aneurysm.
What size iliac artery aneurysm requires surgery? ›The diameter of the common iliac artery is approximately 1 cm on average. Considering the threshold for AAA, approximately 3 cm has conventionally been the threshold for surgical intervention.
How common is a iliac artery aneurysm? ›Isolated iliac artery aneurysm are uncommon, accounting for <2% of abdominal aneurysms.
What is the difference between an aortic embolism and an aortic aneurysm? ›The difference between these two conditions is how they cause blood to stop flowing. With an aneurysm, a vessel can burst, causing internal bleeding. This, in turn, disrupts blood from getting to the organs. With an embolism, blood flow is blocked by a particle that's lodged in a vessel.
Is the iliac a vein or artery? ›Each side of your body has an external and internal iliac vein. These veins are peripheral blood vessels, which means they are far from your heart. Iliac arteries run alongside the iliac veins.
What is the difference between the common iliac artery and the external iliac artery? ›The internal iliac artery supplies the pelvis, pelvic organs, reproductive organs, and the medial part of the thigh. The external iliac artery is the largest branch of the common iliac artery, and it forms the main blood supply to the lower extremity.
Where is the iliac aorta located? ›The pelvis is the lower part of your torso, just above where your legs connect at the hips. The iliac arteries branch off of the bottom of the aorta, the large artery coming out of the top of the heart.
What is the ICD 9 for endovascular aneurysm repair? ›| Endovascular aneurysm repair | |
|---|---|
| Endovascular aneurysm repair | |
| Other names | Endovascular aortic repair |
| ICD-9-CM | 39.51, 39.52, 39.7 |
CPT® Code 61697 - Surgery for Aneurysm, Arteriovenous Malformation or Vascular Disease Procedures on the Skull, Meninges, and Brain - Codify by AAPC.
What are the ICD-10 coding guidelines for aneurysm? ›ICD-10-CM Code for Aneurysm of unspecified site I72.
What is CPT code 36245? ›
CPT® Code 36245 - Intra-Arterial (Catheter and Infusion Pump) Procedures - Codify by AAPC.
What is the CPT code for fenestrated endovascular aortic aneurysm repair? ›CPT® Code 34848 - Fenestrated Endovascular Repair Procedures of the Visceral and Infrarenal Aorta - Codify by AAPC.
What is endovascular stenting of aortic aneurysm? ›Endovascular surgery is performed inside your aorta using thin, long tubes called catheters to place a stent surrounded with a fabric liner to reinforce the weak spots. You may be eligible for endovascular stent grafting if your aneurysm has not ruptured and the aneurysm is 5 centimeters or more in size.