This page addresses follow-up questions and additional information pertinent to our webinar
Endovascular Aneurysm Repair ICD-10-PCS Coding: A Deep Dive from Aorta to Iliac.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic, as they can change rapidly.

Q: What clinical factors or patient-specific considerations would lead a physician to select a fenestrated endovascular aneurysm repair (FEVAR) instead of a standard endovascular aneurysm repair (EVAR)?
A: FEVAR is typically considered when the aneurysm’s location or anatomy does not permit adequate proximal sealing and fixation with a standard endograft. This is most commonly encountered in patients with juxtarenal or pararenal abdominal aortic aneurysms, where the proximity to the renal arteries limits the available landing zone for conventional EVAR.

Q: How is placement of parallel grafts (e.g., snorkels, chimneys, periscopes) coded during endovascular aneurysm repair?
A: Parallel grafts that are not part of a manufactured branched or fenestrated device (such as FEVAR, TBE, or TAMBE) are reported separately using the root operation Insertion. The intent of these grafts is to maintain perfusion to branch vessels, not to dilate a stenotic artery. Therefore, coding them with the root operation Dilation would be inappropriate, as the primary objective is vessel patency rather than luminal expansion.

Q: If extensions are placed to extend the length of an endograft, is there a separate code assignment?
A: No. The placement of extension components to lengthen an endograft is not separately reportable. These components are considered integral to the overall endovascular repair, as they support the primary objective of excluding the aneurysm by maintaining an adequate seal and fixation. Therefore, no additional code is assigned for their placement.

Q: What is the PCS body part value for TEVAR?
A: The PCS body part value for Thoracic Endovascular Aortic Repair (TEVAR) depends on whether the endograft involves the cervicocerebral vessels within the aortic arch. These vessels include the brachiocephalic artery, left common carotid artery, and left subclavian artery. If the endograft involves the aortic arch (i.e., includes any of the cervicocerebral vessels), the correct body part value is Thoracic Aorta, Ascending Arch. If the endograft does not involve the aortic arch (i.e., excludes those vessels), the correct body part value is Thoracic Aorta, Descending.