Q & A with Dr. David Zielske

Question: Renal snorkel stents with aorto-uniiliac prosthesis

Dr. Z, I appreciate your insight on the more complex AAA coding scenarios (using Category III CPT codes 0078T, 0079T for fenestrated modular bifurcated prosthesis). However, for the aorto-uniiliac prosthesis (34805) with renal snorkel stents, should the conventional stent codes 37205/37206 be used (with catheter placement code 36245 and stent RS&I)? Op note:

PREOPERATIVE DIAGNOSIS: Abdominal aortic aneurysm. Left internal iliac artery aneurysm. Bilateral common iliac artery aneurysm, complex anatomy. POSTOPERATIVE DIAGNOSIS: Abdominal aortic aneurysm. Left internal iliac artery aneurysm. Bilateral common iliac artery aneurysm, complex anatomy. OPERATION PERFORMED: Complex endovascular aneurysm repair with an aorto uni right iliac Medtronic Endurant device with coil embolization, left internal iliac artery aneurysm. Plug Medtronic occluder device, left common iliac artery, with additional coils placed. Right-to-left femoral-femoral bypass, bilateral renal artery covered stents in a "snorkel" technique and intravascular ultrasound.

Answer

Sounds like the IVUS, the 34805/75952 for the aortoiliac device, the catheter placements for this, and the snorkels can be coded; the descriptions for 0078T-0081T are for aneurysms involving visceral vessels, so the coding for placement of the snorkels in the renals falls into this group. In 2014, there is a change in these codes, and it appears to be more specific to devices that have fenestrations. More to come on that later! The occluder 34808 and the additional embolization 37204/75894 (to change in 2014 also) should be coded.