Highmark Medicare Services, Inc.

12102, 12202, 12302, 12501, 12301, 12201, 12401

MAC Part A & B

A47791

Article

No

Endovascular Repair of Aortic Aneurysms

Pennsylvania, Maryland, District of Columbia, NEW JERSEY, DELAWARE

07/11/2008

09/01/2008

N/A

Coding Guidelines 

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Radiographic studies and procedures related to device selection and sizing performed on dates of service prior to the date of device placement may be separately billed.

Endovascular repair of aortic aneurysms requires the combined effort of radiologists and vascular surgeons. These procedures have several key components:

• Open exposure of the artery to allow delivery of the endovascular prosthesis
• Introduction of guidewires and catheters
• Fluoroscopic guidance in conjunction with endovascular repair
• Placement of the prosthesis

Artery Exposure

To report the open exposure of the artery use codes 34812, 34820, 34833, or 34834 dependent upon the artery used.

When reporting surgical exposure of the artery by the same physician who performed the primary endovascular aortic aneurysm repair, use the code specific to the artery (e.g., femoral: 34812, iliac: 34820) and append the -51 modifier (multiple procedures).

When bilateral arteries are surgically exposed, append the -50 modifier (bilateral procedure) to the appropriate code.

If an extensive repair or replacement of the exposed artery is required, this should be billed with the codes 35266 or 35286.

Introduction of Guidewires and Catheters 

Catheter introduction should be reported using the appropriate catheterization codes as follows:

• For repair of a descending thoracic aneurysm use CPT codes 36140, 36200-36218 as appropriate.
• 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 endovascular AAA repair, append the -51 modifier to the appropriate catheterization code.

Fluoroscopic Guidance in Conjunction with Endovascular Repair 

For repair of a descending thoracic aneurysm use CPT codes 75956-75959 as appropriate.

For repair of an abdominal aortic aneurysm use CPT codes 75952 or 75953.

Reimbursement for 75952 includes angiography of the AORTA for diagnostic imaging if another angiogram has been performed within the previous three months.

CPT code 75953 for fluoroscopic guidance in conjunction with endovascular aneurysm repair includes the analogous services for placement of additional extension prostheses (not for routine components of modular devices).

When multiple provider claims are filed for codes 75952 and 75953, payment will be made to the first performing provider claims received.

Placement of the Prosthesis 

For the replacement of the descending thoracic aneurysm with an endovascular prosthesis use codes 33880-33891.

Several codes may be used when repairing an abdominal aortic aneurysm. Use codes 34802, 34803, 34804, or 34805 for the repair of an abdominal aortic aneurysm with an endovascular prosthesis. Use the additional codes 34825 and 34826 if an extension of that prosthesis is required. If an iliac artery occlusion devise is required use code 34808. Code 34813 is used if a femoral-femoral prosthetic graft is required during the endovascular repair of the abdominal aortic aneurysm. If the abdominal aortic aneurysm cannot be repaired via an endovascular approach and an open approach must be used to complete the procedure, use codes 34830, 34831, or 34832.

Other Billing Considerations 

Other interventional procedures performed at the time of endovascular abdominal aortic aneurysm repair may be additionally reported (e.g., renal transluminal angioplasty, arterial embolization, intravascular ultrasound, balloon angioplasty of native artery(s) outside the graft (e.g., aortic or iliac) before and after deployment of the endoprosthesis). Any stenting performed in the target treatment zone of the endograft before, during, or after placement of the endograft is included with the work of endograft placement. There are, however, indications for placement of vascular stents outside the target treatment zone of the graft (e.g., iliac, renal arteries). These stent placements are to be coded using CPT 37205 or 37206 if performed using a percutaneous approach or using CPT 37207 or 37208 if performed through a surgical arteriotomy.

When the endovascular repair of AAA is performed by cooperating physicians, each participant should report the appropriate repair codes (34800-34832) and append modifier -62 (co-surgeons) or modifier -80 (assistant surgeon). The -62 modifier should not be reported with codes 75952 and 75953.

In situations in which a cardiologist, for example, 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, e.g., the interpretation only. When a -52 modifier is reported, documentation is required with the claim submission.

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

11x Hospital-inpatient (including Part A)

12x Hospital-inpatient or home health visits (Part B only)

85x Specialty facility or ASC surgery-rural primary care hospital (eff 10/94)

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to his coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

036x Operating Room Services

Surgical Services