When to use CPT code 34701 and 34702
The physician introduces, positions, and deploys an endograft to treat abdominal aortic conditions, with or without rupture, such as an aneurysm, pseudoaneurysm, dissection, penetrating ulcer, or traumatic disruption located in the infrarenal abdominal aorta that may or may not extend into the iliac arteries. A covered stent may be referred to using terms such as endovascular graft, endoprosthesis, endograft, or stent graft. The infrarenal aortic endograft may be an aortic tube device, a bifurcated unibody device, a modular bifurcated docking system with docking limbs, or an aorto-uni-iliac device. The abdominal aortic treatment zone is defined as the infrarenal aorta. This procedure requires a vascular surgeon and a radiologist. For CPT code 34701, an incision is made over the femoral artery, which is normally used for access, and a guidewire is threaded into the blood vessel.
A catheter with a stent-transporting tip is advanced over the guidewire into the vessel. The catheter carries the aortic tube prosthesis, approximately 6 inches long and contained inside a holding capsule, through the arterial tree to the site of the aortic infrarenal aneurysm. Once the stent is in proper position, the holding capsule is removed and the stent is deployed, expanding like a spring to anchor itself to normal walls of the aorta above and below the aneurysm. The device serves as a substitute channel for blood flow. If full expansion of the prosthesis does not occur, or leaks are present, a balloon catheter is threaded to the graft site and inflated within the prosthesis until full expansion is achieved and leaking is stopped. The catheter/guidewire is removed and the arteriotomy site is closed. The aneurysm, excluded from the blood flow, typically shrinks over time. The treatment zone for endograft procedures is defined by those vessels that contain an endograft (main body, docking limbs, and/or extensions) deployed during that operative session.
CPT code 34702 is reported when endovascular repair is performed on a ruptured aneurysm in the aorta. Rupture is defined as clinical and/or radiographic evidence of acute hemorrhage. A chronic, contained rupture is considered a pseudoaneurysm and its endovascular treatment is reported with 34701. Nonselective catheterization is included in these codes. Balloon angioplasty and/or stenting at the sealing zone of an endograft is an integral part of the procedure. Fluoroscopic guidance and radiological supervision and interpretation in conjunction with endograft repair is not reported separately, and includes all intraprocedural imaging (e.g., angiography, rotational CT) of the aorta and its branches prior to deployment of the endovascular device, fluoroscopic guidance, and roadmapping used in the delivery of the endovascular components, and intraprocedural and completion angiography (e.g., confirm position, detect endoleak, evaluate runoff) performed at the time of the endovascular infrarenal aorta repair.
34701 Endovascular 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)
34702 ; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)
When to use CPT code 34703, 34704, 34705 and 34706
The physician introduces, positions, and deploys an endograft to treat abdominal aortic conditions, with or without rupture, such as an aneurysm, pseudoaneurysm, dissection, penetrating ulcer, or traumatic disruption located in the infrarenal abdominal aorta that may or may not extend into the iliac arteries. A covered stent may be referred to as an endovascular graft, endoprosthesis, endograft, or stent graft. The infrarenal aortic endograft may be an aortic tube device, a bifurcated unibody device, a modular bifurcated docking system with docking limbs, or an aorto-uni-iliac device. For CPT code 34703 and 34704, the abdominal aortic treatment zone is typically defined as the infrarenal aorta and ipsilateral common iliac artery. In 34705 and 34706, the abdominal aortic treatment zone is typically defined as the infrarenal aorta and both common iliac arteries. These procedures require a vascular surgeon and a radiologist. In 34703, under general anesthesia, a small incision is made in the groin over one femoral artery or both femoral arteries through which the endovascular devices are inserted. If contralateral femoral access is necessary, a percutaneous sheath may be placed.
An aorta-uni-iliac prosthetic graft device contained inside a plastic holding capsule is threaded through the arteries to the site of the infrarenal aneurysm. The endograft is deployed by slowly removing the holding capsule away from the endograft, with continual monitoring of exact positioning. Once the prosthesis is in place, the holding capsule is removed. Balloon angioplasty is performed at the ends of the prosthesis to expand and seat the graft. Stents are deployed within the body of the endograft to maintain expansion forces. The aorta-uni-iliac prosthetic endograft is supported along its length by a series of metal rings sutured to the graft and is held in place by the radial force applied by the rings to the patient’s aorta. Once in place, the arteriotomy site is closed. CPT code 34705 is reported for simultaneous bilateral iliac artery aneurysm repairs with aorto-bi-iliac endograft.
Assign CPT code 34704 and 34706 when endovascular repair is performed on a ruptured aneurysm in the aorta or iliac arteries. Rupture is defined as clinical and/or radiographic evidence of acute hemorrhage. A chronic, contained rupture is considered a pseudoaneurysm and its endovascular treatment is reported with 34703 and 34705. Nonselective catheterization is included in 34703, 34704, 34705, and 34706. Balloon angioplasty and/or stenting at the sealing zone of an endograft is an integral part of the procedure. Fluoroscopic guidance and radiological supervision and interpretation in conjunction with endograft repair is not separately reported, and includes all intraprocedural imaging (e.g., angiography, rotational CT) of the aorta and its branches prior to deployment of the endovascular device, fluoroscopic guidance and roadmapping used in the delivery of the endovascular components, and intraprocedural and completion angiography (e.g., confirm position, detect endoleak, evaluate runoff) performed at the time of the endovascular infrarenal aorta and/or iliac repair.
34703 Endovascular 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)
34704 ; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)
34705 Endovascular 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)
34706 ; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)
When to use CPT code 34707 and 34708
The physician introduces, positions, and deploys an ilio-iliac endograft for treatment of isolated arterial pathology (with or without rupture), such as an aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, or trauma involving the iliac artery. The treatment zone is defined as the portion of the iliac artery (e.g., common, internal, external iliac arteries) involved. The procedure requires a vascular surgeon and a radiologist. The patient receives medication (Heparin) to help prevent blood clots prior to the procedure. For CPT code 34707, under general anesthesia, the physician makes a small incision near the patient’s hip bone area to enter the iliac artery. A proprietary device is used, which is comprised of two main components: a trunk component and a contralateral leg component. The endoprosthesis, contained inside a holding device, is introduced into the artery under fluoroscopy and positioned at the target zone area of repair by threading guidewires and catheters. Nonselective catheterization is included. CPT code 34708 is reported when endovascular repair is performed on a ruptured aneurysm in the iliac artery. Rupture is defined as clinical and/or radiographic evidence of acute hemorrhage.
A chronic, contained rupture is considered a pseudoaneurysm, and its endovascular treatment is reported with 34707. Balloon angioplasty and/or stenting at the treatment zone of an endograft is an integral part of the procedure. Fluoroscopic guidance and radiological supervision and interpretation, in conjunction with endograft repair, are not reported separately. Included are all intraprocedural imaging (e.g., angiography, rotational CT) of the iliac artery prior to deployment of the endovascular device, fluoroscopic guidance and roadmapping used in the delivery of the endovascular components, and intraprocedural and completion angiography (e.g., confirm position, detect endoleak, evaluate runoff) performed at the time of the endovascular iliac repair.
34707 Endovascular 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)
34708 ; for rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)
+ 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)
(Use 34709 in conjunction with 34701, 34702, 34703, 34704, 34705, 34706, 34707, 34708)
When to use CPT code 34710 and 34711
he physician performs delayed endovascular placement of a distal or proximal extension prosthesis to repair an infrarenal abdominal aortic or iliac aneurysm, pseudoaneurysm, dissection, endoleak, or endograft migration. A leak may occur at fixation sites of a grafted aneurysm through the body of the graft or from patent arteries within the aneurysm sac and may require endovascular reparation. Using separately reportable aortography, the target site is identified. The proper extension prosthesis is selected. Under separately reportable fluoroscopy, the extension prosthesis, contained inside a long plastic holding capsule, is threaded through the arteries to the leak site. Once the extension prosthesis is in place, the holding capsule is removed. The extension prosthesis, activated by heat, expands like a spring and becomes anchored to the artery wall at the site of the endoleak.
If full expansion of the prosthesis does not occur automatically, a balloon catheter is threaded to the graft site and inflated within the endovascular prosthesis until full expansion is achieved. The catheter is removed and the arteriotomy site is closed. These procedures include all nonselective catheterizations, sizing, and device selection prior to the procedure; radiological supervision and interpretation; and treatment zone angioplasty or stenting, when performed. These codes may only be reported once per vessel treated (e.g., multiple endograft extensions placed in a single vessel may only be reported once). CPT code 34710 is reported for placement of an extension prosthesis in the initial vessel and CPT code 34711 for placement of an extension prosthesis in each additional vessel.
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
+34711 ; each additional vessel treated (List separately in addition to code for primary procedure)
When to use CPT code 34712
The physician performs transcatheter delivery of accessory-enhanced fixation devices, such as an anchor, screw, or tack, to the endograft. Commonly referred to as a bioprosthesis, this procedure is used for patients with abdominal aortic and/or iliac artery conditions, such as an aneurysm with complex anatomies, or for patients who are experiencing an endoleak. Proprietary devices ensure a safe and effective treatment solution for these types of repairs. They enhance durability to the level of a surgical anastomosis and address concerns for future complications. They are used to improve fixation and sealing of an endovascular graft, either in primary cases or to fix endoleaks and stent migration.
The devices lock the endograft to the abdominal aorta and/or iliac artery to secure the patient’s future and maximize outcomes in challenging patients. The fixation devices quickly identify, aim, and activate a sealing mechanism to close up endoleaks. Endoanchors are used to repair an endovascular graft in cases where the original graft has moved away from the implant site and developed endoleaks. In such cases, augmented fixation and/or sealing is required to regain or maintain effective aneurysm exclusion. These devices can be placed during the initial endoprosthesis placement procedure or for a subsequent repair procedure. Percutaneous access using a sheath smaller than 12 French is included in CPT code 34712 and is not reported separately. Radiologic supervision and interpretation are included in this procedure.
34712 Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation
+ 34713 Percutaneous 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)
+ 34714 Open 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)
+ 34715 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure)
+ 34716 Open 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)