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 rupture and death; arterial or venous thrombosis and/or pseudoanrupture and death; arterial or venous thrombosis and/or pseudoanbowel complications (e.g., ileus, transient ischemia, infarction, necroIndications The Endurant ® IIII/Endurant® bifurcated stent graftGraft is indicated Endurant® IIs Stent Systemfor the endovascu- bowel MRI Safety and Compatibility (e.g., ileus,and transient ischemia, infarction, necro-(e.g. sis);complications cardiac complications subsequent attendant problems The Endurant ® II bifurcated stent graft is indicated the endovascular treatment of infrarenal abdominal aortic or for aorto-iliac aneurysms. sis); cardiac Non-clinical testing has demonstrated that the Endurant II/ complications and subsequent attendant problems (e.g. arrhythmia, myocardial infarction, congestive heart failure, hypotenIndications lar treatment of infrarenal abdominal aortic orgraft aorto-iliac aneurysms. The Endurant II aorto-uni-iliac (AUI) stent is indicated for the Endurant IIs Stent Graft is MR Conditional. It can be scanned arrhythmia, myocardial infarction, congestive heart failure, hypotension, hypertension); claudication (e.g., buttock, lower limb); death; The Endurant® II/Endurant® IIs bifurcated stent graft indicated The Endurant II aorto-uni-iliac stent graft is indicated for the endovascular treatment of(AUI) infrarenal abdominal aortic orisaortoiliac in embolization both 1.5T & 3.0T MR (e.g., systems under certain conditions sion,safely hypertension); claudication buttock, lower limb); death; edema; (micro and macro) with transient or permanent for the endovascular treatment of infrarenal aortic endovascular treatment of whose infrarenal abdominal or aortoiliac aneurysms in patients anatomy doesaortic notabdominal allow the use of aor edema; as described in the(micro product Instructions fortransient Use. For additional embolization and macro) with or permanent aorto-iliac The Endurant II aorto-uni-iliac (AUI) aneurysms in patients whose does not allowsystem the useis of astent information regarding MRI please refer to the product Instructions bifurcated stentaneurysms. graft. Theanatomy Endurant II stent graft indicated genitourinary complications and subsequent attendant problems graft is indicated for the endovascular treatment ofindicated infrarenal bifurcated stent graft. The Endurant II stent graft system is for Use. complications and subsequent attendant problems for use in patients with the following characteristics: genitourinary abdominal aortic or aortoiliac aneurysms in patients whose for use in patients with the following characteristics: • Adequate iliac/femoral access is compatible Adverse Events incontinence, hematuria, infection); hepatic failure; impotence; infecanatomy does not allow thethat use of a bifurcatedwith stentvascular graft. The • Adequate iliac/femoral access that is compatible with vascular Potential adverse events include (arranged in alphabetical access techniques, devices and/or accessories incontinence, hematuria, infection); hepatic impotence; infection of the aneurysm, device access site,failure; including abscessorder): formation, Endurant II/Endurant IIs stent graft system is indicated for use in access techniques, devices and/or accessories amputation; anesthetic complications and subsequent attendant tion of the aneurysm, device access site, including abscess formation, transient fever and pain; lymphatic complications and subsequent • Proximal neck length of ≥10 mm patients with the following characteristics: problems aspiration), aneurysm enlargement; aneurysm transient fever(e.g., and pain; lymphatic complications and subsequent • Proximal neck neck length of ≥10 mm • Infrarenal angulation of ≤60° • Adequate iliac/femoral access that is compatible with rupture and death; aortic damage, including perforation, complications and subsequent attendant problems (e.g., confusion, • Infrarenal angulation ≤60° vascular accessof techniques, • Aorticneck neck diameters with a rangedevices of 19 toand/or 32 mmaccessories dissection, bleeding, rupture and paraplegia, death; arterial or venous complications and subsequent attendant problems (e.g., confusion, stroke, transient ischemic attack, paraparesis, paralysis); • Aortic withlength a range 19mm to 32 mm • diameters Proximal neck of of ≥10 • neck thrombosis and/or pseudoaneurysm; arteriovenous fistula; stroke, transient ischemic attack, paraplegia, paraparesis, paralysis); occlusion of device or native vessel; pulmonary complications and • bleeding, hematoma or coagulopathy; bowelcomplications complicationsand • Iliac diameters with a range of 8 toof25 mm • Infrarenal neck angulation ≤60° occlusion of device or native vessel; pulmonary subsequent attendant problems; renal complications and subse(e.g., ileus, transient ischemia, infarction, necrosis); cardiac • Iliac• diameters with a range 8 to 25 mm subsequent attendantproblems problems;(e.g., renal complications subseMorphology forofaneurysm quent attendant artery occlusion, and contrast toxicity, • Aorticsuitable neck diameters with arepair range of 19 to 32 mm complications and subsequent attendant problems (e.g., • Morphology suitable for aneurysm repair quent attendant problems (e.g., artery occlusion, contrast toxicity, Contraindications • Distal fixation length(s) of ≥15 mm arrhythmia, myocardial infarction, congestive heart failure, Contraindications incomplete component deployment; component migration; suture The Endurant II Stent Graft is of contraindicated hypotension, hypertension); claudication (e.g., buttock, lower • Iliac diameters withSystem a range 8 to 25 mm in: incomplete component deployment; component migration; suturekinkbreak;death; occlusion; infection; stent fracture; graftmacro) twisting and/or The Endurant II Stent Graft System is contraindicated in: limb); edema; embolization (micro and with • Patients who have a suitable condition threatens to infect the graft. • Morphology forthat aneurysm repair break; occlusion; infection; stent fracture; graft twisting and/or kinktransient or permanent ischemia or infarction; endoleak; fever • Patients whowith haveknown a condition that threatens to infect graft.materials. • Patients sensitivities or allergies to thethe device Contraindications and localized inflammation; genitourinary complications and • Patients with known sensitivities or allergies to the device materials. Warnings and Precautions repair; vascular access problems site complications, including infection, pain, The Endurant II/Endurant IIs Stent Graft System is contraindicated in: subsequent attendant (e.g., ischemia, erosion, femoralWarnings and Precautions repair; vascular access site complications, including infection, pain, • femoral artery thrombosis, fistula, incontinence, hematuria, • Patients who have a condition that threatens to infect the graft. • System has not been established. All patients should be advised that cular spasm or vascular (e.g., iliofemoral dissection, infection); hepatic failure;trauma impotence; infection ofvessel the aneurysm, not • Patients with known All sensitivities should or allergiesadvised to the device System has been established. that spasmaccess orrupture, vascular traumavessel (e.g., iliofemoral vessel dissection, endovascular treatment requires patients lifelong, regularbe follow-up to assess culardevice bleeding, death); damage; wound complications and site, including abscess formation, transient materials. endovascular treatment requires lifelong, regular follow-up to assess bleeding, rupture, death); vessel damage; wound complications and the health and the performance of the implanted endovascular stent subsequent attendant problems (eg, dehiscence, infection, hemafever and pain; lymphatic complications and subsequent Warnings and Precautions the health and the performance of the implanted endovascular stent subsequent attendant problems (eg,fistula); dehiscence, infection, toma, seroma, cellulitis). attendant problems (e.g., lymph neurologic localhemaor • T he long-term safety and effectiveness of the Endurant II/ toma, seroma, cellulitis). aneurysms or changes in the structure or position of the endovassystemic complications and subsequent problems Please reference product Instructions forattendant Use for more information IIs the Stent Graft System has not established. aneurysms orEndurant changes in structure or position ofbeen the endovas(e.g., confusion, stroke, transient ischemic attack, paraplegia, Please reference product Instructions for Use for more information and regarding indications, warnings, precautions, contraindications All patients should be advised that endovascular treatment paraparesis, paralysis); occlusion of devicecontraindications or native vessel; and guidelines are described in the Instructions for Use. regarding indications, warnings, precautions, adverse events. lifelong, follow-up to assess the health pulmonary and subsequent attendant problems; guidelines arerequires described in theregular Instructions for Use. adverse events. complications • CAUTION: Federal (USA) law restricts this device to sale by or on the and the performance of the implanted endovascular stent renal complications and subsequent attendant problems (e.g., • aneurysmgraft. expansion, persistent endoleaks may (e.g., be required to CAUTION: (USA) law restricts this device to sale by or on the order ofFederal a physician. Patientsand with specific clinical findings endoleaks, artery occlusion, contrast toxicity, insufficiency, failure); stent aneurysm expansion, andinterventions persistent endoleaks may be required to undergo secondary or surgical procedures. of a physician. enlarging aneurysms or changes in the structure or position ordergraft: improper component placement; incomplete component undergo or surgical procedures. • Thesecondary Endurant IIinterventions Stent Graft System is not recommended in followpatients of the endovascular graft) should receive enhanced deployment; component migration; suture break; occlusion; • Theunable Endurant II Specific Stent Graft System is not patients toup. undergo orfollow-up who will guidelines not be recommended compliant withinthe necessary are described in the infection; stent fracture; graft twisting and/or kinking; insertion unable to undergo or who will not be compliant with the necessary preoperative and postoperative imaging and implantation studies as Instructions for Use. and removal difficulties; graft material wear; dilatation; erosion; preoperative postoperative imaging implantation studies described in the Instructions forreduced Use. andblood puncture and perigraft flow; surgical conversion to open repair; • and Patients experiencing flow through theasgraft described the Instructions for Use. • 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 stent graft. The radiundergo secondary interventions or surgical agents. 2) As marker aprocedures. resultalong of emboli or a misplaced stent Thebe radivascular spasm or vascular trauma (e.g., iliofemoral vessel opaque the edge of the stent graftgraft. should aligned dissection, bleeding, rupture, death); vessel damage; wound 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 to undergo or who will dehiscence, infection, hematoma, seroma, cellulitis) • Studies that the danger micro-embolization increases not be compliant the necessary preoperative and with indicate increased duration of with theofprocedure. Please reference product Instructions for Use for more information with•increasedpostoperative duration of the procedure. imaging and implantation studies as described 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 refer • Revaluated enal complications may 1) From an excess usetoof the been product Instructions for Use foroccur: details. CAUTION: Federal (USA) law restricts this device to sale by or on the product Instructions for Use 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 along the edge of the stent MRI Safety and Compatibility: testing has demonstrated that the Endurant II Stent Non-clinical Graft is MR Conditional. It can be scanned graft should be aligned immediately below the lower-most that safely the Endurant Stent GraftMR is MR Conditional. It can conditions be scannedas www.medtronic.com in both II1.5T & 3.0T systems under certain origin. safelydescribed in bothrenal 1.5T &arterial 3.0T MR systems under conditions as informa- www.medtronic.com Product Services in the product Instructions forcertain Use. For additional Medtronic Tel:Services 888.283.7868 3576 Unocal Place Studies indicate that danger of micro-embolization Product described in•the 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
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