Knowing How to Appropriately Code for Rupture Versus Aneurysm and Other Circumstances

Vascular embolization can prove challenging for many coders. Knowing the fundamentals of vascular embolization is important for successful CPT® coding. By gaining better comprehension of these services, healthcare coding and billing professionals can help ensure accurate coding while safeguarding full reimbursement. Let’s take a look at

Understanding the circumstances and requirements for rupture coding can be complicated for many CPT® coders. By gaining better comprehension of this situation and service, coding accuracy increases while protecting regulatory compliance and recapturing potentially lost revenue.

As you may know, CPT allows for several available different codes to report each of the four types of stent-graft placements. Understand that each code choice option is broken into a code to specify  for “other than rupture” and “for rupture.” The following reasons for “other than rupture” can be:

• for aneurysm
• pseudoaneurysm
• dissection
• penetrating ulcer

 What do the codes for rupture encompass? The codes “for rupture” will include temporary balloon occlusion whether performed or not. Note that repair for rupture is expected to involve more time, skill, and risk on the part of the provider.

Rupture (as related to this code set) is defined as:

• “Clinical and/or radiographic evidence of acute hemorrhage.”

Understand that rupture repair may be performed for the same four reasons as above as well as traumatic disruption.

Circumstances Surrounding Rupture

The procedure for rupture is completed on an emergency basis and is not considered elective since patients undergoing the procedure tend to be much sicker than normal. Recovery may prove to be longer, and patients may require subsequent procedures (i.e., the initial graft may not be long enough, etc.). Understand that there is no one specific type of device that could be used to treat a rupture. As such, any covered stent “counts” regarding coding for this service.

These codes should be assigned if during a routine angioplasty or stent placement in the aorta or iliac arteries rupture occurs and is treated by covered stent placement. Also, know that rupture codes may be assigned when there is hemorrhage, and the patient is not stable (hemodynamically). It is important to note that rupture codes should not be used when the rupture is subintimal or otherwise contained (patient is hemodynamically stable). The associated codes may also be applied to traumatic rupture as well.

Stay on the Alert for Odd vs. Even Coding

So how do we separate which codes to use? Even-numbered codes will specify treatment for rupture:

• 34702 (aorto-aortic tube graft)

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 rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

• 34704 (aorto-uni-iliac endograft)

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 rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

• 34706 (aorta-bi-iliac endograft)

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 rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, penetrating ulcer, traumatic disruption)

• 34708 (ilio-iliac tube graft)

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 rupture including temporary aortic and/or iliac balloon occlusion, when performed (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, traumatic disruption)

However, odd-numbered codes will refer to treatment of non-Rupture (i.e., aneurysm, pseudoaneurysm, dissection, penetrating ulcer):

• 34701 (aorto-aortic tube graft)

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)

• 34703 (aorto-uni-iliac endograft)

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)

• 34705 (aorta-bi-iliac endograft)

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)

• 34707 (ilio-iliac tube graft)

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)

What would we report to code for the repair of a contained/chronic rupture?

It is important to note that if treating a rupture that is considered chronic, and if contained would be considered a pseudoaneurysm. As such, codes 34701, 34703, 34705, or 34707 would be assigned instead of the codes for “rupture.”

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