Until the release of CPT 2001, endovascular repairs for abdominal aortic aneurysm (AAA) were billed with the unlisted-procedure code 37799 (unlisted procedure, vascular surgery), because there were no specific codes for these procedures. Now that unique codes are in place, such as 34800 (endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis), 34802 (... using modular bifurcated prosthesis [one docking limb]) and 34804 (... using unibody bifurcated prosthesis), anesthesiology coders must know how to bill for associated anesthesia service in both routine and unusual circumstances.
As an alternative to more invasive methods, endovascular repair of AAA involves placing a stent graft within the lumen of the aorta and usually the iliac(s). Under fluoroscopic guidance, the graft is threaded through the femoral artery to the surgical site. These procedures can be done under epidural anesthesia, as well as under monitored anesthesia care (MAC) and general anesthesia. Mary Klein, coding specialist with Panhandle Medical Services of Pensacola, Fla., says, "The anesthesiologist places the arterial and central venous lines, and monitors the patient throughout the case. Usually the surgical team comprises a vascular surgeon and a radiologist. The anesthesiologist is considered ancillary to the procedure and not a member of the surgical team, so you would not append a co-surgery modifier to the procedure code to bill the anesthesiologist's services."
During endovascular repair, the surgeon might perform additional procedures to complete the treatment successfully, such as an artery occlusion to block a stenosed iliac artery to prevent retrograde blood flow into the aorta. In turn, this procedure requires the surgeon to place a femoral-femoral prosthetic bypass graft to maintain blood flow into the affected leg. Theresa Ruiz-Law, director of managed care and reimbursement with the American Association of Nurse Anesthetists in Chicago, says, "Under Medicare payment policies, the anesthesiologist can only bill for the procedure with the highest base value, plus the total time of the procedure. The associated procedures would be considered as add-ons to the primary surgical code, with no corresponding anesthesia codes
. In this scenario, therefore, the anesthesiologist bills 34800 to indicate the primary procedure, and CPT anesthesia code CPT 00770 (anesthesia for all procedures on major abdominal blood vessels).
"Some coders might use CPT 00880 (anesthesia for procedures on major lower abdominal vessels; not otherwise specified) rather than 00770 to indicate anesthesia for AAA repairs involving lower abdominal incisions," notes Barbara Johnson, CPC, MPC, professional coder at Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif.
"For billing other payers, check with your carries to determine how they want you to bill anesthesia services performed with multiple surgical procedures," Ruiz-Law says.
When an Open Procedure Replaces AAA Repair
AAAs can be [...]