Local Coverage Article: Endovascular Repair of Aortic Aneurysms (A53124)

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1 Local Coverage Article: Endovascular Repair of Aortic Aneurysms (A53124) Contractor Information Contractor Name Novitas Solutions, Inc. Article Information General Information Article ID A53124 Original ICD-9 Article ID A47791 Article Title Endovascular Repair of Aortic Aneurysms AMA CPT / ADA CDT Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and Original Effective Date 10/01/2015 Revision Effective Date Revision Ending Date Retirement Date

2 CDT-2010 are trademarks of the American Dental Association. Article Guidance Article Text: 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 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.

3 If an extensive repair or replacement of the exposed artery is required, this should be billed with the codes or 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, as appropriate. For repair of an abdominal aortic aneurysm use CPT codes 36200, , and 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 as appropriate. For repair of an abdominal aortic aneurysm use CPT codes or Reimbursement for includes angiography of the AORTA for diagnostic imaging if another angiogram has been performed within the previous three months. CPT code 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 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 Several codes may be used when repairing an abdominal aortic aneurysm. Use codes 34802, 34803, 34804, or for the repair of an abdominal aortic aneurysm with an endovascular prosthesis. Use the additional codes and if an extension of that prosthesis is required. If an iliac artery occlusion device is required use code Code is used if a

4 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 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 Please note, CPT codes now include radiological supervision and interpretation. Therefore, CPT should not be reported in conjunction with these codes. When the endovascular repair of AAA is performed by cooperating physicians, each participant should report the appropriate repair codes ( ) and append modifier -62 (cosurgeons) or modifier -80 (assistant surgeon). The -62 modifier should not be reported with codes and 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. Coding Information 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. Bill Type Codes Information Table 011x Hospital Inpatient (Including Medicare Part A) 012x Hospital Inpatient (Medicare Part B only) 085x Critical Access Hospital

5 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 this 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. The Revenue Codes Information Table 036X Operating Room Services - General Classification CPT/HCPCS Codes Group 1 Paragraph: Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes. Group 1 Codes: CPT/HCPCS Codes Information Table opens in new window Endovasc taa repr incl subcl - Car-car bp grft/endovas taa opens in new window Endovas aaa repr w/sm tube - Xpose endoprosth brachial Repair blood vessel lesion Repair blood vessel lesion Establish access to artery opens in new window Place catheter in aorta - Place catheter in artery opens in new window Ins cath abd/l-ext art 1st - Ins cath abd/l-ext art addl Open/perq place stent 1st Open/perq place stent ea add Open/perq place stent same Open/perq place stent ea add Endovasc repair abdom aorta Abdom aneurysm endovas rpr opens in new window Xray endovasc thor ao repr - Xray place dist ext thor ao ICD-10 Codes that are Covered ICD-10 Codes that are Not Covered

6 Revision History Information Associated Documents Related Local Coverage Document(s) Related National Coverage Document(s) Statutory Requirements URL(s) Rules and Regulations URL(s) CMS Manual Explanations URL(s) Other URL(s) Public Version(s) Updated on 08/06/2014 with effective dates 10/01/ Keywords Read the Article Disclaimer opens in new window

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