Transcript Endovascular AAA Stent Grafts Inpatient Reimbursement Reference

Endovascular AAA Stent Grafts Inpatient Reimbursement Reference Guide
These suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The provider of services
is ultimately responsible for correct coding.
Physician Coding for Inpatient Procedures: Endovascular Repair of the AAA
The following CPT codes will be paid as inpatient procedures ONLY.
Procedure
CPT Code
CPT Code Description
Bilateral open
femoral exposure
34812 Modifier options:*
-50 (bilateral)
-62 (co-surgeons)
-80 (asst. surgeon)
Open femoral artery exposure for delivery of endovascular prosthesis,
by groin incision, unilateral
CPT Code for Radiologic S & I
Catheter placement
in aorta from both groins
36200 Modifier options:*
-50 (bilateral)
Introduction of catheter, aorta
Placement of
fem-fem graft
34813 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Placement of femoral-femoral prosthetic graft during endovascular aortic
aneurysm repair (list separately in addition to code for primary procedure)
Deploy stent graft (bifurcated
and one contralateral limb)
34802 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection;
using modular bifurcated prosthesis (one docking limb)—90-day global period
Note: All PTA/stenting within target zone of graft is included in this code
Deploy stent graft (bifurcated
and two docking limbs)
34803 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection;
using modular bifurcated prosthesis (two docking limbs)—90-day global period
Note: All PTA/stenting within target zone of graft is included in this code
Deploy stent graft (aortouni-iliac or aorto-uni-femoral
prosthesis)
34805** Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection;
using aorto-uni-iliac or aorto-uni-femoral prosthesis —90-day global period
Note: All PTA/stenting within target zone of graft is included in this code
Placement of additional
proximal or distal
extension(s) — initial vessel
34825 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Placement of proximal or distal extension prosthesis for endovascular repair of
infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; initial
vessel —90-day global period
Placement of additional
proximal and/or distal
extension(s) — each
additional vessel
34826 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Placement of proximal or distal extension prosthesis for endovascular repair of
infrarenal abdominal aortic or iliac aneurysm, false aneurysm, or dissection; each
additional vessel (list separately in addition to code for primary procedure)
Placement of iliac
occluder plug
34808 Modifier options:*
-62 (co-surgeons)
-80 (asst. surgeon)
Endovascular placement of iliac artery occlusion device
(list separately in addition to code for primary procedure)
75952 Endovascular repair of infrarenal
abdominal aortic aneurysm or dissection, radiological
supervision and interpretation
Modifier options:* -26 (professional component)
75953 Placement of proximal or distal extension
prosthesis for endovascular repair of infrarenal aortic
or iliac artery aneurysm, pseudoaneurysm; or
dissection, radiological supervision and interpretation
Modifier options:* -26 (professional component)
Utilizing CPT Codes with the Medtronic AAA Stent Grafts
These suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The provider of services is ultimately responsible for correct coding.
Endurant® II Abdominal
Stent Graft
Endurant® IIs Stent Graft
34802:
Bifurcated graft
and docking limb
Endurant® II AUI
34803:
Bifurcated graft
and docking limbs
Extensions
34805:
AUI graft
34825/34826:
Aortic Extension,
Iliac Extensions
Placement of proximal
or distal extensions,
initial vessel/each
additional vessel.
Hospital Inpatient Coding: Endovascular Repair of the AAA
* Other coding modifiers could possibly be used. The options listed here are common
ones used with these CPT codes.
** The placement of an iliac limb may or may not be included with 34805.
Please contact our Reimbursement team at 877-347-9662 for any questions.
Definition
Code
Nomenclature
ICD-9 diagnosis code
441.4
Abdominal aortic aneurysm without mention of rupture
ICD-9 surgical code
39.71
Endovascular implantation of graft in abdominal aorta
Related MS-DRGs
237
Major cardiovascular procedures with MCC
238
Major cardiovascular procedures without MCC
N/A
The procedure associated with this device is approved in the
inpatient setting only. C-Codes are reported with device-dependent
procedures on outpatient claims; therefore no C-Code applies
HCPCS (C-Code)
Endurant® II Stent Graft System
Endurant®
II Stent Graft System
Indications
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incontinence,
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and pain;
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including
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neck
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subsequent
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Contraindications
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subsequent
attendant
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femoralWarnings
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site
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pain,
•
femoral
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hematuria,
• Patients who have a condition that threatens to infect the graft.
•
System has not been established. All patients should be advised that
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or vascular
(e.g., iliofemoral
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hepatic
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materials.
endovascular
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to
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death);
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complications
and
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subsequent
attendant
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and subsequent
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guidelines are described in the Instructions for Use.
regarding
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events.
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and the performance of the implanted endovascular stent
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Patientsand
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endoleaks,
artery
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contrast
toxicity,
insufficiency,
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aneurysm
expansion,
andinterventions
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may
be required to
undergo
secondary
or surgical
procedures.
of a physician.
enlarging
aneurysms or changes
in the
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component
placement;
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undergo
or surgical
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is not
patients
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undergo
orfollow-up
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compliant
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are described
in
the
infection; stent fracture; graft twisting and/or kinking; insertion
unable
to
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who
will
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Instructions
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and removal difficulties; graft material wear; dilatation; erosion;
preoperative
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studies
described
in the
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puncture and perigraft flow; surgical conversion to open repair;
• and
Patients
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described
the
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• Renalincomplications
may
occur:
1)
From
an
excess
use
of
contrast
vascular access site complications, including infection, pain,
limb, aneurysm expansion, and persistent endoleaks may
• Renal
complications
mayto
1) or
From
an excess
use of
contrast
hematoma, pseudoaneurysm, arteriovenous fistula, dissection;
agents.
2)be
Asrequired
a result
ofoccur:
emboli
a misplaced
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The
radiundergo
secondary
interventions
or
surgical
agents.
2) As marker
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Thebe
radivascular spasm or vascular trauma (e.g., iliofemoral vessel
opaque
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should
aligned
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opaque
marker
along
the
edge
of
the
stent
graft
should
be
aligned
immediately
below
the
lower-most
renal
arterial
origin.
• The Endurant II/Endurant IIs Stent Graft System is not
complications and subsequent attendant problems (e.g.,
immediately
below
the
lower-most
renal
arterial
origin.
• Studies recommended
indicate that the
danger ofunable
micro-embolization
increases
in patients
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• Studies
that
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not be
compliant
the
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and
with indicate
increased
duration
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Please reference product Instructions for Use for more information
with•increasedpostoperative
duration of the
procedure.
imaging
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regarding indications, warnings, precautions, contraindications
in theevaluated
Instructions
for Use.patient populations. Please refer to
•
has not been
in some
and adverse events.
has not
in some
patient
populations.
Please
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• Revaluated
enal
complications
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1) From an
excess
usetoof
the been
product
Instructions
for Use
foroccur:
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CAUTION: Federal (USA) law restricts this device to sale by or on
the product
Instructions
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forNon-clinical
contrast
agents.
2) As
adetails.
result of emboli
a misplaced
stent
MRI Safety
and Compatibility:
testingorhas
demonstrated
the order of a physician.
graft.
The
radiopaque
marker
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edge
of
the
stent
MRI Safety
and
Compatibility:
testing has demonstrated
that the
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II Stent Non-clinical
Graft is MR Conditional.
It can be scanned
graft
should
be
aligned
immediately
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the
lower-most
that safely
the Endurant
Stent
GraftMR
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It can conditions
be scannedas
www.medtronic.com
in both II1.5T
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Product Services
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additional
Medtronic
Tel:Services
888.283.7868
3576 Unocal Place
Studies
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Product
described
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product
Instructions
For
additional
information regarding
MRI
please
referthe
tofor
theUse.
product
Instructions
for Use. Medtronic
Fax: 800.838.3103
Santa Rosa,
CA 95403
Tel:
888.283.7868
3576
Unocal
Place
increases
with
increased
duration
of
the
procedure.
tion Adverse
regardingEvents
MRI please refer to the product Instructions for Use.
Reimbursement Information
USA CA 95403
Fax: 800.838.3103
Santa Rosa,
Telephone: 877.347.9662
Adverse
Events
•
T
he
safety
and effectiveness
of the in
Endurant
II/Endurant
Reimbursement
Information
Potential adverse
events
include (arranged
alphabetical
order):IIs USA Tel: 707.525.0111
Telephone: 877.347.9662
Tel:
707.525.0111
Stent
Graft
System
has
not
been
evaluated
in
some
patient
Potential
adverse anesthetic
events include
(arranged and
in alphabetical
amputation;
complications
subsequentorder):
attendant
populations.
Please
refer to
the
product Instructions
Use
amputation;
anesthetic
complications
and
subsequent
attendantfor
problems
(e.g. aspiration),
aneurysm
enlargement;
aneurysm
rupture
for
details.
problems
(e.g. aspiration),
aneurysm
enlargement;
aneurysm
rupture
and death;
aortic damage,
including
perforation,
dissection,
bleeding,
CPT® is a trademark of the American Medical Association.
and death; aortic damage, including perforation, dissection, bleeding,
For distribution in the USA only. © 2014 Medtronic, inc. All rights reserved. Printed in USA UC201103425bEN 9/14
CPT® is a trademark of the American Medical Association.
CPT®
is a reserved.
trademarkPrinted
of the in
American
Medical Association.
For distribution in the USA only. © 2014 Medtronic, inc. All
rights
USA UC201103425bEN
9/14
10168447DOC © Medtronic, inc. 2014. All rights reserved. Printed in USA. For distribution in the USA only. 10/14