Branched endograft placement
Two new codes (34717 and 34718) have been created for deployment of a branched or bifurcated endograft within the iliac arteries, in the setting placement or revision of aorto-iliac endografts. These codes include all pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed.
Previously, this work was reported with the Category III code 0254T, which has now been deleted.
34717 is an add-on code for branched endograft placement performed in the same session as an initial aorto-iliac artery endograft placement (34703, 34704, 34705 or 34706). It describes deployment of a bifurcated endograft in the common iliac artery with extension(s) into both the internal iliac and external iliac arteries, or common femoral artery when performed, to maintain perfusion in these vessels. Branched endografts are indicated for treatment of iliac artery pathology (with or without rupture) such as aneurysm, pseudoaneurysm, dissection, penetrating ulcer, arteriovenous malformation or traumatic disruption. The iliac branched endograft is a multipiece system that consists of a bifurcation device that is placed in the common iliac artery and additional extension(s) are deployed into both the internal iliac artery and external iliac/common femoral arteries as needed, as well as a proximal extension that overlaps with an aorto-iliac endograft, when performed. All additional extensions proximally into the common iliac artery or distally into the external iliac and/or common femoral arteries are included in the branched endograft codes. Therefore, do not report 34717 with 34709, since 34717 includes the work performed for extension placement.
34718 is a stand-alone code that is reported for the placement of a bifurcated endograft at a separate session (different day) from the initial placement of an aorto-iliac endograft placement. 34718 intended to be used in an elective setting and includes all pre-procedure sizing and device selection. 34718 is not be used in the setting of rupture or other acute trauma. For placement of an isolated branched endograph for rupture, report unlisted code 37799.
Both 34717 and 34718 are to be reported one per side. If performed as a bilateral procedure, report the appropriate code twice.
+ 34717 Endovascular repair of iliac artery at the time of aortoiliac artery endograft placement by deployment of an iliac branched endograft including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for rupture or other than rupture (e.g., for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer, traumatic disruption), unilateral
(Use 34717 in conjunction with 34703, 34704, 34705, 34706)
• 34718 Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (e.g., for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral
Diagnostic and therapeutic lumbar puncture
Similar to the changes we saw last year with the fine needle aspiration codes, there have been revisions to the CPT codes in the lumbar puncture family that distinguish between the service being performed with or without imaging guidance. Language in the existing CPT codes 62270 and 62272 have been revised and these codes should be reported when performed without imaging guidance. Two new codes (62328 and 62329) have been created bundling fluoroscopic or CT guidance with the LP procedure. If an LP is performed with US or MR guidance, then 76942 or 77022 can be reported in conjunction with 62270 or 62272.
▲ 62270 Spinal puncture, lumbar, diagnostic
• 62328 Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance
▲ 62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)
• 62329 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance
3D printing anatomic models
Four new Category III codes have been created (effective July 1, 2019) to report the work performed in developing and printing 3D anatomic models and subsequent fashioning of cutting/drilling guides. CPT codes 0559T and 0560T are to be reported when printing 3D models of anatomic structures, such as (but not limited to) bones, arteries, veins, nerves, ureters, muscles, tendons and ligaments, joints, visceral organs, and brains. 0561T and 0562T are to be reported when printing cutting or drilling guides. It may be necessary to make a 3D-printed model and a 3D-printed cutting or drilling guide on the same patient to assist with surgery. These codes should not be reported in conjunction with 3D rendering codes 76376 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image postprocessing under concurrent supervision, not requiring image postprocessing on an independent workstation) or 76377 (3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound or other tomographic modality with image postprocessing under concurrent supervision, requiring image postprocessing on an independent workstation). As Category III codes, there is no assigned work RVU value and these codes are typically carrier priced, so check with your local carriers on reimbursement for these codes.
• 0559T Anatomic model 3D-printed from image data set(s); first individually prepared and processed component of an anatomic structure
+ 0560T Anatomic model 3D-printed from image data set(s); each additional individually prepared and processed component of an anatomic structure (List separately in addition to code for primary procedure)
• 0561T Anatomic guide 3D-printed and designed from image data set(s); first anatomic guide
+ 0562T Anatomic guide 3D-printed and designed from image data set(s); each additional anatomic guide (List separately in addition to code for primary procedure)
Duplex scan for preoperative mapping of hemodialysis access
Two new codes (93985 and 93986) have been established as Category I codes describing duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to the creation of hemodialysis access. This exam was previously reported with G0365. These codes should only be reported when a full and completed evaluation of both the arterial inflow and venous outflow are performed for preoperative assessment prior to creation of a hemodialysis access.
• 93985 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study
• 93986 Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study
Disclaimer: SIR is providing this billing and coding guide for educational and information purposes only. It is not intended to provide legal, medical or any other kind of advice. The guide is meant to be an adjunct to the American Medical Association’s (AMA’s) Current Procedural Terminology (2019/CPT®). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers and coders. Therefore, a precise knowledge of the definitions of the CPT descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service.
Every reasonable effort has been made to ensure the accuracy of this guide; but SIR and its employees, agents, officers and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guide will prevent differences of opinion or disputes with payers. The publication is provided “as is” without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this manual. The ultimate responsibility for correct use of the Medicare and AMA CPT billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize the information in this guide in a manner inconsistent with the coverage and payment policies of any payers, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.
