EVAR, FEVAR, TEVAR procedures are becoming widely popular for the treatment of thoracic and abdominal aortic aneurysm due to their noninvasive techniques that ultimately speed up the patient recovery time frame. The patient hospital stay can be decreased from seven days with an open repair to just two days with an endovascular repair. Understanding procedural terminology, vascular territories, access types, sheath placement and more are vital for proper coding and maximum reimbursement. Below I will provide the code sets used, their description and the coding guidelines for these procedures.
The term "endograft" is interchangeable with stent graft, endovascular graft, covered stent, and endoprosthesis. The term "extension" can refer to any covered stent.
EVAR= Endovascular Aortic Aneurysm Repair.
TVAR= Thoracic Aortic Endovascular Aneurysm Repair.
FEVAR= Fenestrated Endovascular Aneurysm Repair.
Coding Guidelines for CPTs 34701-34713:
Includes:
Closure artery after endograft delivery using sheath size less than 12 French
Treatment with covered stent for:
Aneurysm
Aortic dissection
Arteriovenous malformation
Pseudoaneurysm
Trauma
Treatment zones (vessel(s) in which endograft deployed):
Iliac artery(ies) (34707-34708, [34717], [34718])
Infrarenal aorta (34701-34702)
Infrarenal aorta and both common iliac arteries (34705-34706)
Infrarenal aorta and ipsilateral common iliac artery (34703-34704)
Excludes:
Treatment atherosclerotic occlusive disease with covered stent:
Aorta (37236-37237)
Iliac artery(ies) (37221, 37223)
Code also open arterial exposure, when appropriate ([34812], 34714 [34820, 34833, 34834], 34715-34716)
Code also percutaneous closure artery when endograft delivered through sheath 12 French or larger (34713)
Code also selective catheterization arteries outside target treatment zone
34701Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer). S&I Code is Bundled.
34702Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the aortic bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the aortic bifurcation; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption). S&I Code is Bundled.
34703Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer). S&I Code is Bundled.
34704Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption). S&I Code is Bundled.
34705Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer). S&I Code is Bundled.
34706Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft extension(s) placed in the aorta from the level of the renal arteries to the iliac bifurcation, and all angioplasty/stenting performed from the level of the renal arteries to the iliac bifurcation; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption). S&I Code is Bundled.
34707Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation). S&I Code is Bundled.
34708Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally to the iliac bifurcation, and treatment zone angioplasty/stenting, when performed, unilateral; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption). S&I Code is Bundled.
34709 Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed, per vessel treated (List separately in addition to code for primary procedure). S&I Code is Bundled.
34710 Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; initial vessel treated. S&I Code is Bundled.
34711Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; each additional vessel treated (List separately in addition to code for primary procedure). S&I Code is Bundled.
34712Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation. S&I Code is Bundled.
34713Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure). S&I Code is Bundled.
34717 Endovascular repair of iliac artery at the time of aorto-iliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for rupture or other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer, traumatic disruption), unilateral (List separately in addition to code for primary procedure).
34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral.
Coding Guidelines for CPTs 33880-33891:
Includes:
Balloon angioplasty
Introduction, manipulation, placement, and device deployment
Stent deployment
Excludes:
Additional interventional procedures provided during endovascular repair
Carotid-carotid bypass (33891)
Guidewire and catheter insertion (36140, 36200-36218)
Open exposure artery/subsequent closure ([34812], 34714-34716 [34820, 34833, 34834])
Subclavian to carotid artery transposition (33889)
Substantial artery repair/replacement (35226, 35286
33880Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin. S&I Code 75956.
33881Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin. S&I Code 75957.
33883Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); initial extension. S&I Code 75958.
33884Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); each additional proximal extension (List separately in addition to code for primary procedure). S&I Code 75958.
33886Placement of distal extension prosthesis(s) delayed after endovascular repair of descending thoracic aorta. S&I Code 75959.
Coding Guidelines for CPTs 34839-34848:
Includes:
Angiography
Balloon angioplasty before and after graft deployment
Fluoroscopic guidance
Guidewire and catheter insertion vessels in target treatment zone
Radiologic supervision and interpretation
Visceral aorta (34841-34844)
Visceral aorta and associated infrarenal abdominal aorta (34845-34848)
Excludes:
Catheterization:
Arterial families outside treatment zone
Hypogastric arteries
Distal extension prosthesis terminating in common femoral, external iliac, or internal iliac artery (34709-34711 [34718])
Insertion bare metal or covered intravascular stents in visceral branches in target treatment zone (37236-37237)
Interventional procedures outside treatment zone
Open exposure access vessels (34713-34716 [34812, 34820, 34833, 34834])
Placement distal extension prosthesis into internal/external iliac or common femoral artery (34709, [34718], 34710-34711)
Repair abdominal aortic aneurysm without fenestrated graft (34701-34708)
Substantial artery repair (35226, 35286)
Code also associated endovascular repair descending thoracic aorta (33880-33886, 75956-75959)
34839 Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time.
34841 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery).
34821 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
34843 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
34844 Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
34845 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery).
34846 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including two visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
34847 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including three visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
34848 Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including four or more visceral artery endoprostheses (superior mesenteric, celiac and/or renal artery[s]).
Coding Guidelines for CPTs 34812-34832
Includes:
Balloon angioplasty/stent deployment within target treatment zone
Introduction, manipulation, placement, and device deployment
Open exposure femoral or iliac artery/subsequent closure
Thromboendarterectomy at site of aneurysm
Excludes:
Additional interventional procedures outside target treatment zone
Guidewire and catheter insertion (36140, 36200, 36245-36248)
Substantial artery repair/replacement (35226, 35286)
34812Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure).
34813Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm repair (List separately in addition to code for primary procedure).
34714Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure). S&I Code Bundled
34820Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure).
34833Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure).
34834Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (List separately in addition to code for primary procedure).
34715Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure). S&I Code Bundled.
34716Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure). S&I Code Bundled.
34830Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis.
34831Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis.
34832Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis.
Coding Guidelines for CPTs 37236-37239.
Includes:
Arteriotomy closure by suturing puncture, pressure, or arterial closure device application
Balloon angioplasty
Post-dilation after stent deployment
Predilation performed as primary or secondary angioplasty
Treatment lesion inside same vessel but outside stented portion
Treatment using different-sized balloons to accomplish procedure
Endovascular revascularization arteries and veins other than carotid, coronary, extracranial, intracranial, lower extremities
Imaging once procedure complete
Radiological supervision and interpretation
Stent placement provided as only treatment
Excludes:
Angioplasty in unrelated vessel
Extensive repair or replacement artery (35226, 35286)
Insertion multiple stents in single vessel using more than one code
Intravascular ultrasound (37252-37253)
Mechanical thrombectomy (37184-37188)
Selective and nonselective catheterization (36005, 36010-36015, 36200, 36215-36218, 36245-36248)
Stent placement in:
Cervical carotid artery (37215-37216)
Extracranial vertebral (0075T-0076T)
Hemodialysis circuit (36903, 36905, 36908)
Intracoronary (92928-92929, 92933-92934, 92937-92938, 92941, 92943-92944)
Intracranial (61635)
Intrathoracic common carotid or innominate artery, retrograde or antegrade approach (37218)
Lower extremity arteries for occlusive disease (37221, 37223, 37226-37227, 37230-37231, 37234-37235)
Visceral arteries with fenestrated aortic repair (34841-34848)
Thrombolytic therapy (37211-37214)
Ultrasound guidance (76937)
Code also add-on codes for different vessels treated during same operative session.
37236Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery.
37237Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure).
37238Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; initial vein.
37239Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure).
Coding Guidelines for CPTs 37246-37247
Includes:
Open and percutaneous balloon angioplasty
Radiological supervision and interpretation (37220-37235)
Excludes:
Angioplasty other vessels:
Aortic/visceral arteries (with endovascular repair) (34841-34848)
Coronary artery (92920-92944)
Intracranial artery (61630, 61635)
Performed in hemodialysis circuit (36901-36909)
Infusion thrombolytics (37211-37214)
Mechanical thrombectomy (37184-37188)
Pulmonary artery (92997-92998)
Reporting codes more than one time for all services performed in single vessel or treatable with one angioplasty procedure.
Code also angioplasty different vessel, when performed ([37247], [37249])
Code also extensive artery repair or replacement, when performed (35226, 35286)
Code also intravascular ultrasound, when performed (37252-37253)
37246Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery.
37247Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure).
Coding Guidelines for CPTs 37241-37242
Includes:
Embolization or occlusion arteries, lymphatics, and veins except for head/neck and central nervous system
Imaging once procedure complete
Intraprocedural guidance
Radiological supervision and interpretation
Roadmapping
Stent placement provided as support for embolization
Excludes:
Embolization code assigned more than once per operative field
Head, neck, or central nervous system embolization (61624, 61626, 61710)
Multiple codes for indications that overlap, code only indication needing most immediate attention
Stent deployment as primary aneurysm management, pseudoaneurysm, or vascular extravasation
Vein destruction with sclerosing solution (36468-36471)
Code also additional embolization procedure(s) and appropriate modifiers (e.g., modifier 59) when embolization procedures performed in multiple operative fields
Code also diagnostic angiography and catheter placement using modifier 59 when appropriate
37241Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles).
37242Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms).
How To Apply These Codes
EVAR Rules:
Non-selective catheter placements are bundled with EVAR and iliac endografts. Non-selective and selective catheter placements are also bundled with bifurcated iliac endografts.
Access codes are considered unilateral add on codes and should be reported one time with a 50 modifier. the MUE on codes 34812, 34820, 34833, & 34834 is 1, do not report these codes twice.
34709 is considered an add on code to cpts 34701-34708. CPT 34709 should only be reported for extensions placed at the time of initial implantation and only for those placed in the internal iliac, external iliac, and suprarenal abdominal aorta. For any extension placed in the common iliacs & infrarenal aorta are bundled. 34709 is considered an add on code to cpts 34701-34708.
34709 should only be reported once for each iliac system and once in the aorta for a maximum of three times. If three extension are placed in one iliac, only submit cpt 34709 one time.
CPT 34710 & 34711 should be reported when a delayed placement of extensions is performed. Do not report with cpt codes 34701-34708.
CPT 34713 for percutaneous access and closure when using a 12 French sheath or larger should be reported once per side and bundles 76937 for ultrasound guidance. Do not report 34713 for sheaths less than 12 French, Use CPT 34812 for open femoral exposure during these procedures.
Selective catheter placements, IVUS, and non-target vessel embolization are separately reported. Angioplasty & stent placement in vessels other than the stent graft deployment vessel(s) are also separately reportable. Non-selective catheter placements are bundled in addition to angioplasty & stent placement performed in the same vessel as the main graft, docking limb(s), or extensions.
The following imaging of the aorta and its branches are bundled; angiography, 3D CT, FU imaging, LE run-off, fluoroscopy and supervision/interpretation.
Any addition beyond the initial docking limb's landing site vessel is considered and extension limp or cuff. Coding rules only allow one extension code per side regardless of the number of extension devices delivered in a single vessel. There are five vessels considered with EVARs; RT/LT internal and and external iliacs and the aorta proximal to the renal arteries.
DO NOT-
DO NOT code for road mapping, guiding shots, or other contrast injections during intervention.
DO NOT code for follow-up angiography post intervention as it is included in the endovascular S&I codes.
DO NOT code angioplasty to deploy a stent or stent graft.
DO NOT code angioplasty to further dilate or completely deploy a newly placed stent or stent graft.
DO NOT code angioplasty if the intent of the procedure was to place a stent or stent graft.
DO NOT code for any balloon angioplasty treatment within the zone of aortic or iliac stent graft placement.
FEVAR Rules
CPT codes 34841-34848 are used to describe work done with aortic stent grafts with fenestrations that allow placement of the visceral endoprosthesis through the endograft fenestrations.
aortic extensions are not reported as they are bundled with CPT codes 34841-34844 however you can report extensions into the internal & external iliacs and common femoral arteries.
CPT code 34839 is reported for physicians that spend at least 90 minutes of planning and sizing of patient specific FEVAR and appropriately documents this time. CPT 34839 cannot be submitted for work performed on the day of or the day before the actual FEVAR procedure. Typically the planning and sizing for CPT 34839 is done a couple weeks prior to the procedure.
Stent graft extensions in the aorta or common iliac arteries are bundled. Extensions into the internal iliac, external iliac, or common femoral arteries can be reported with 34709 once per side. Delayed stent graft extensions in the proximal aorta after the initial FEVAR procedure are coded with thoracic stent graft codes.
TEVAR Rules
TEVAR procedures are described in codes 33880-33886, 75956-75959. These codes allow coding for each additional proximal extension.
If the left subclavian artery is covered while deploying and extension proximal to the initial thoracic component the reported CPT codes will change from 33833/75958 to 33880/75956.
CPT code 33886/75959 can only be reported once regardless of the number of delayed distal extensions that are placed at the same subsequent session.
Do not code for distal extensions placed concurrently with an initial thoracic endograft placement as they are bundled.
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Citing and Sources
Optum Encoder Coding Reference 2021
Dr. Z's Medical Coding Series Vascular & Endovascular Surgery 2019
CMS CPT Manual 2021 Edition