Guidelines and Related Medical Codes for Reporting Abdominal Aortic Aneurysm (AAA)

Hello everyone and welcome to our podcast series. My name is Natalie Tornese and I am a billing manager at Outsource Strategies. I want to talk a little bit about Abdominal Aortic Aneurysms also referred to as AAA. I will go over the condition as well as some coding guidelines.

AAA refers to the stretching and blood-filled bulging in a part of the aorta that runs through your abdomen. The aorta runs from your heart through the center of your chest and abdomen. It’s the main blood vessel that supplies oxygen-rich blood from the heart to the rest of the body. The AAA occurs when an area of the aorta becomes very large or balloons out. Being the largest blood vessel, the aorta can cause serious problems if it enlarges or ruptures. It can lead to severe pain and massive internal bleeding, or hemorrhaging. It can be very risky condition, if it’s not detected early and treated correctly. Depending on the size of the aneurysm and its speed of growth, treatment modalities will vary. If the physician determines that the patient’s aneurysm is small and not growing fast, it is safe to just watch the aneurysm carefully. On the other hand, if it becomes large and is about to rupture, emergency surgery may be the safest choice. In some cases, physicians may put in a type of graft called a stent to fix the aneurysm without doing any major surgery.

According to reports from Medscape.com, ruptured AAA is the 13^th leading cause of death in the US. It causes an estimated 15,000 deaths per year. It generally classified on the basis of their size and at the speed at which they are grow. Small or slow growing AAAs, less than 5.5 centimeters have a low risk of rupture. On the other hand, a large or fast-growing one are greater than 5.5 centimeters are more likely to rupture. As I said a rupture can cause internal bleeding and other serious complications. The size and the speed of growth are the two main factors that help predict the health effects of the aneurysm and decide further treatment options. The larger the aneurysm, the more likely it is to be treated with surgery. These types of aneurysms also need to be treated if they are causing symptoms or if they are leaking blood. Physicians who often recommend that it is safer to monitor the aneurysms with regular abdominal ultrasounds than to treat them.

The cause of these aneurysms is unknown, however, certain factors have been shown to increase the risk factors associated with the condition. These risk factors include smoking, people with atherosclerosis, vascular inflammation, family history of heart disease or heart conditions, high cholesterol, blood pressure, previous aneurysms, bacterial fungal infection in the aorta and also obesity. In addition, men who are older than 65 and have peripheral atherosclerotic vascular disease are at the greatest risk of suffering an aneurysm. Some aneurysms remain small, while others grow. If they grow slowly without any symptoms, abdominal aortic aneurysms are difficult to detect until they rupture. In some cases, certain types of aneurysms will never rupture. Common symptoms of an enlarging aneurysm include:

• Sudden pain in your abdomen or back
• Pain that spreads from your abdomen or back to your pelvis, legs, or buttocks
• A pulsating feeling near the navel
• Dizziness and shortness of breath
• Or increased heart rate

The diagnosis always starts with a detailed clinical exam, where the physician may check for any specific bulge in your aneurysm. They may order a diagnostic tests like chest X-ray, abdominal ultrasound, CT scan of the abdomen , may be an MRI may be preformed to analyze the nature of bulge. Treatment modalities involve careful medical monitoring or surgery to prevent them from rupturing. Physicians may perform surgery to repair or remove the damaged tissue depending on the size, rate of growth and the location of the aneurysm. Regular imaging tests will be performed to check you know for any changes in the size of the aneurysm.

Most aortic aneurysms do not cause any specific symptoms like I said until they rupture, which is why they are so dangerous. They can progressively dilate over time and one of the biggest concerns is that it can rupture and cause that significant internal bleeding, which can be fatal. It is imperative to screen those people at risk, and once diagnosed, the size of the aneurysm  should be monitored periodically. And really large ones should of course be surgically repaired before they rupture.

The primary way of screening includes an abdominal ultrasound. This screening test is easy to perform, its non-invasive and does not involve radiation. It’s highly highly accurate. The potential benefit of screening and detecting and repairing it before it ruptures is our greatest concern.  When filing claims for screening tests, you know you should always use certain CPT codes to ensure proper billing and reimbursement.

I will include a transcript along with this podcast outlining those associated codes.

( CPT code for AAA

• 76706 – Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)

CPT Codes

In 2018, 16 new codes (34701–34716) were added for endovascular repair of abdominal aorta and/or iliac arteries and four related codes (34812, 34820, 34833, and 34834) were revised. The newly added CPT codes include –

• 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 fromthe 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/oriliac balloon occlusion, when performed (eg,for aneurysm, pseudoaneurysm, dissection,penetrating ulcer, traumatic disruption)
• 34703 – Endovascular repair of infrarenal aorta and/or iliacartery(ies) by deployment of an aorto-uni-iliacendograft including pre-procedure sizing anddevice selection, all nonselective catheterization(s), all associated radiological supervision andinterpretation, all endograft extension(s) placedin the aorta from the level of the renal arteries tothe iliac bifurcation, and all angioplasty/stentingperformed from the level of the renal arteries tothe iliac bifurcation; for other than rupture)
• 34704 -For rupture including temporary aortic and/oriliac 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)
• 34707 – Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including preprocedure 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)

CPT Codes to Report Open Repair of Infrarenal Aortic Aneurysm

In case of failed endovascular aortic repair, physicians will recommend open surgery. The relevant CPT codes include –

• 34830 – Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis
• 34831– Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis
• 34832– Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis
• 35081– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta
• 35082– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta
• 35091– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)
• 35092– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteric, celiac, renal)
• 35102– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric, external)
• 35103– Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving iliac vessels (common, hypogastric, external)

ICD-10 Codes for abdominal aortic aneurysm repair

I71 – Aortic aneurysm and dissection

• I71.0 – Dissection of aorta
  • I71.02 – Dissection of abdominal aorta
  • I71.03 – Dissection of thoracoabdominal aorta
• I71.3 – Abdominal aortic aneurysm, ruptured
• I71.4 – Abdominal aortic aneurysm, without rupture
• I71.5 – Thoracoabdominal aortic aneurysm, ruptured
• I71.6 – Thoracoabdominal aortic aneurysm, without rupture
• I71.8 – Aortic aneurysm of unspecified site, ruptured
• I71.9 – Aortic aneurysm of unspecified site, without rupture )

The U.S. Preventive Services Task Force’s recently published recommendations for abdominal aortic aneurysm screening and how to code for this potentially life-saving test. The new screening guidelines apply to adults that are aged 50 year older who do not have any signs or symptoms of AAA. The screening guidelines include:

• Men aged 65 to 75 years old who have never smoked. They should have a one-time test for abdominal aortic aneurysm with ultrasonography. Men aged 60 years and older with a family history should consider regular screening of this condition.
• Clinicians selectively offer screening for men aged 65 to 75, who have never smoked rather than routinely screening all men in this group.
• The task force recommends against routine screening with ultrasonography in women who have never smoked and have no family history.

Reporting this condition of course and this task can be very complex. So it’s really important that you understand exactly what you are looking to bill out and what type of reimbursement you are looking for.

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!