Tips for Getting Open Repair Medical Billing Right

When a patient presents with an abdominal aneurysm, there is usually a graft repair procedure performed. This usually involves exposing the affected portion of the aorta with a large incision (via a transabdominal or retroperitoneal approach), temporarily occluding (stopping) the blood flow, opening the aneurysm, and inserting a tubular prosthesis. The wound technically remains open during this time and should be handled as an open repair.

The medical billing code to use for this type of open procedures is 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) for repairs confined to the abdominal aorta or 35102 (… for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta involving iliac vessels) for repairs that involve the abdominal aorta and one or both iliac vessels. The key to making an exact determination will be found in the PH or in the notations of the physician and refer to them when you’re building your medical documentation for the necessity of the procedure.

However, this reporting will chance if the site has been previously closed. Open repair following endovascular attempt calls for special coding expertise to be used. An example would be when an open cholecystectomy follows an attempted laparoscopic cholecystectomy, you should report only the open procedure.

A variation to this scenario would be when the surgeon must perform an open AAA repair following an attempted endovascular repair (either during the same session or during the global period of the endovascular repair), you won’t report the standard open repair codes and should instead rely on 34830-34832 (Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair…), depending on the type of prosthesis the surgeonultimately places (tube, aorto-bi-iliac or aorto-bifemoral).

And last but not least, if the open repair occurs during the global period of an earlier endovascular repair attempt, be sure to append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to procedures that fit code range 34830-34832, as the situation calls for.

View all Articles by: Melissa Clark, CCS-P