34802

Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis (1 docking limb)

Endovascular aneurysm repair (EVAR) is a highly specialized, minimally invasive surgical procedure utilized by vascular surgeons to treat an abdominal aortic aneurysm (AAA) or an aortic dissection. The historical CPT code 34802 specifically delineates the endovascular repair of an infrarenal abdominal aortic aneurysm or dissection employing a modular bifurcated prosthesis with one docking limb. An infrarenal aneurysm is located entirely below the renal arteries, which is a critical anatomical requirement for this specific endograft configuration to ensure the preservation of blood flow to the kidneys. During the procedure, the patient is prepped and draped in a sterile fashion, typically under general or regional anesthesia. The vascular surgeon accesses the bilateral common femoral arteries via percutaneous puncture techniques or small surgical cutdowns. Working under continuous fluoroscopic guidance, a series of guidewires, sheaths, and catheters are carefully navigated through the iliac arteries and advanced into the abdominal aorta. A comprehensive intraoperative angiogram is then executed to precisely identify the anatomical landmarks, specifically the lowest renal artery and the aortic bifurcation, mapping the exact length and diameter of the aneurysm. The primary component of the modular bifurcated stent graft, referred to as the main body, is introduced over a stiff guidewire through the ipsilateral femoral artery. It is meticulously deployed just below the renal arteries. This main body features one long limb that extends into the ipsilateral common iliac artery and a shorter stump, known as the docking limb. Subsequently, through the contralateral femoral artery access, a separate guidewire is maneuvered up and directed into the short docking limb of the previously deployed main graft. The contralateral limb prosthesis is then tracked over this wire and deployed, successfully bridging the short stump to the contralateral common iliac artery. This completes the bifurcated construction, effectively creating an inverted Y-shaped conduit that completely excludes the aneurysm sac from systemic arterial pressure. By relining the diseased aorta, the modular bifurcated prosthesis significantly mitigates the risk of catastrophic aneurysmal rupture while maintaining unobstructed perfusion to the bilateral lower extremities. Post-deployment balloon dilation is routinely performed at the attachment sites to secure a robust seal and prevent type I or type III endoleaks. It is imperative to note that CPT code 34802 was officially deleted from the CPT manual in 2018 and has been systematically replaced by the updated EVAR code series (e.g., 34705), which comprehensively bundles the radiological supervision and interpretation into the primary interventional code.

Clinical Indications

  • Abdominal aortic aneurysm (AAA) measuring greater than 5.5 cm in diameter in men or 5.0 cm in women.
  • Rapidly expanding abdominal aortic aneurysm demonstrating a growth rate of more than 0.5 cm in 6 months.
  • Symptomatic infrarenal abdominal aortic aneurysm presenting with unexplained abdominal, back, or flank pain.
  • Aortic dissection involving the infrarenal aorta with appropriate anatomical criteria.
  • Patient is deemed high risk for traditional open surgical repair but possesses suitable aortoiliac anatomy for endovascular stent graft placement.

Procedure Steps

  1. The patient is placed under general, regional, or local anesthesia depending on clinical status and surgeon preference.
  2. Bilateral access to the common femoral arteries is secured via percutaneous puncture or open surgical cutdown.
  3. Sheaths, guidewires, and catheters are systematically advanced under continuous fluoroscopic guidance into the abdominal aorta.
  4. An initial intraoperative angiogram is performed to accurately map the aneurysm, renal arteries, and bilateral iliac bifurcations.
  5. The main body of the modular bifurcated stent graft is advanced over a stiff guidewire into the infrarenal aorta via the ipsilateral approach.
  6. The main graft is precisely positioned immediately below the lowest renal artery and deployed, extending its ipsilateral limb into the common iliac artery.
  7. Through the contralateral femoral access, a guidewire is maneuvered into the short docking limb of the deployed main graft.
  8. The contralateral docking limb prosthesis is advanced over the guidewire into the main graft stump and deployed to complete the bifurcation.
  9. Balloon dilation of all graft attachment zones is performed to ensure a secure seal against the vessel wall and prevent endoleaks.
  10. Completion angiography is executed to confirm the successful exclusion of the aneurysm sac and the absence of endoleaks.
  11. The delivery systems are removed, and the femoral arteriotomies are securely closed with sutures or closure devices.

Coding Guidelines

  • CPT code 34802 was deleted effective January 1, 2018, and replaced by codes 34701-34711.
  • For procedures performed after January 1, 2018, use the appropriate updated EVAR code (e.g., 34705 for infrarenal EVAR using a bifurcated endograft).
  • Historically, code 34802 did not include radiological supervision and interpretation (RS&I), which was required to be reported separately with 75952.
  • Access via femoral artery cutdown (e.g., 34812) or iliac artery access (e.g., 34820) was reported separately if performed when 34802 was active.
  • Balloon angioplasty or stenting performed outside the target treatment zone may be reported separately with appropriate modifiers.
  • If an extension cuff was required during the initial procedure to ensure an adequate seal, it was reported separately with historical codes 34825 or 34826.

Associated ICD-10 Codes