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• W2069968765 abstract "This article presents one institution's follow-up of patients who had endovascular repair of a popliteal artery aneurysm. They identified 64 patients over a mean of 50 months for stent-graft fracture and its impact on patency. They conclude that stent-graft fractures mainly occur at overlap zones, are more common in younger patients, and do not significantly influence patency. Traditional open elective repair of a popliteal artery aneurysm is reported using CPT code 35151. The description states, “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, popliteal artery.” This includes dissection of the inflow and outflow artery, harvest and preparation of the conduit, tunneling the bypass, and any maneuvers to isolate or exclude the popliteal aneurysm itself. When the aneurysm ruptures, CPT code 35152 is more appropriate for the urgent reconstruction and control of hemorrhage. The 2010 Medicare Physician Fee Schedule (MPFS) has valued CPT code 35151 at 36.49 total relative value units (RVUs) while CPT code 35152, with the additional work involved in both an emergency operation as well as a longer inpatient hospital stay, has 42.26 total RVUs. The approach (medial vs. posterior) and the conduit (in-situ vein vs. excised vein vs. prosthetic) do not affect reimbursement. The above descriptions imply the surgeon works on a patent arterial system which includes those thrombosed popliteal artery aneurysms that are successfully opened with a lytic agent. However, if a popliteal artery aneurysm is thrombosed (either acutely or chronically) at the time of operation, the revascularization efforts follow standard infrainguinal arterial bypass reporting for occlusive disease based on inflow artery, outflow artery, and conduit. The physician work involved in such an operation has a higher intensity, is based on limb salvage principles instead of prophylaxis against future thrombo-embolic events, and requires a more involved post-operative care. For example, a femoral artery to peroneal artery bypass using in-situ greater saphenous vein done for ischemic rest pain when the popliteal artery aneurysm is occluded would be best illustrated by CPT code 35585. This procedure is valued at 49.10 total RVUs in the 2010 MPFS. Endovascular popliteal artery aneurysm repair is governed by component coding guidelines for catheter, imaging, and intervention. There is no specific bundled code at this point as seen with uterine fibroid embolization (CPT code 37210) or carotid artery stenting (CPT code 37215 and 37216). Catheter insertion in this manuscript occurred after a limited surgical cutdown on the common femoral artery. The vessel was directly punctured and the catheter/sheath advanced first into the superficial femoral artery and then into the popliteal artery. Antegrade navigation from the common femoral to the popliteal artery constitutes a second order catheterization (CPT code 36246). If the superficial femoral artery was accessed directly and the catheter/sheath then advanced antegrade into the popliteal artery, a first order catheterization is reported (CPT code 36245) instead. Imaging usually involves a unilateral extremity angiogram (CPT code 75710). However, most individuals will have had prior diagnostic evaluation of the arterial tree using some modality. Diagnostic angiography performed at the time of an interventional procedure is separately reportable if: no prior catheter-based angiographic study is available, a full diagnostic study is performed, and the decision to intervene is based on this study. The addition of the -59 modifier to the imaging codes is required for reimbursement in the uncommon situation where no prior arteriogram was undertaken. There are four stent codes for all peripheral vessels (excluding the carotid and vertebral arteries). CPT code 37205 describes percutaneous deployment of the first stent while 37206 is an add-on code used to describe each additional vessel treated percutaneously. Similarly, CPT code 37207 and the add-on code 37208 are used in the open setting. “Open” requires the site of arterial puncture be through a surgically isolated artery as compared to “percutaneous” where the needle is directed through the skin into the vessel. Open stenting bundles the exposure of the artery in the groin as well as direct suture repair after removal of the sheath with the endovascular therapy. CPT code 35226 which depicts direct repair of a lower extremity artery as a separate procedure is not reportable in conjunction with open stenting. To this end, a National Correct Coding Initiative (NCCI) edit exists between 37207 and 35226. All four codes require use of the same radiology supervision and interpretation code (CPT code 75960). It is important to remember that stents are coded per vessel and not per stent. In the procedures described in this manuscript, CPT codes 37207 and 75960 are typically appropriate as they illustrate open stent placement within one vessel (the superficial femoral/above-knee popliteal artery segment). If a femoral endarterectomy or patch angioplasty is required, these codes are separately reportable. Please note that infrainguinal arterial endovascular intervention may change in 2011. Consult your 2011 CPT manual for appropriate coding descriptions." @default.
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• W2069968765 date "2010-06-01" @default.
• W2069968765 modified "2023-09-30" @default.
• W2069968765 title "Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair" @default.
• W2069968765 doi "https://doi.org/10.1016/j.jvs.2010.04.016" @default.
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