Interventional Part

Endovascular Iliac Stent Grafts

7 Vascular Interventional Coding
Endovascular Iliac Stent Grafts Pages: 359-368

Procedure Example(s)
Clinical Indications References
Codes
Coding Instructions

PROCEDURE:
Isolated abnormalities of the iliac arteries lend themselves to endovascular repair due to the
minimally invasive techniques available. This section deals with endovascular stent graft
placement for the treatment of iliac artery aneurysms, pseudoaneurysms, arteriovenous
fistulae, and traumatic injuries. These procedures are not to be confused with iliac aneurysms
that are confluent with an abdominal aortic aneurysm undergoing repair in an endovascular
fashion. The following codes and discussions are not relevant to treatment of iliac stenosis or
occlusion secondary to atherosclerotic vascular disease. The pathology treated can involve the
common or external iliac arteries separately or together, as well as the internal iliac arteries.

The procedure involves either percutaneous or open exposure to the common femoral or iliac
artery, usually ipsilateral. Wire and catheter placement is achieved, followed by
fluoroscopically-guided delivery of a covered stent or stent graft component. Prior to treatment
of the abnormality, angioplasty or stenting of access vessels may be necessary. Occasionally,
non-target embolization is required prior to stent graft placement to avoid endoleak formation.
IVUS may be performed before or after stent graft placement.
Another common location for arterial aneurysm is the popliteal artery. Code 37236 (arterial
stent placement) is recommended to describe placement of a stent graft across a popliteal
aneurysm. Treatment of an iliac aneurysm with a bifurcated iliac stent graft device is reported
with a new technology code.

CLINICAL INDICATIONS:
Isolated iliac artery aneurysm, pseudoaneurysm, arteriovenous fistula, or focal area of
trauma.

CODES:

TS T
O& O
AT I AT
PROCEDURE DESCRIPTION PROC P AL C P AL
CODE CR O CR

VD V
UE U

Endovascular repair of infrarenal aorta and/or iliac artery(ies) ♦ 34703 N 40 B
by deployment of an aorto-uni-iliac endograft including / .2 u
pre-procedure sizing and device selection, all nonselective A5 n
catheterization(s), all associated radiological supervision and dl
interpretation, all endograft extension(s) placed in the aorta e
from the level of the renal arteries to the iliac bifurcation, d
and all angioplasty/stenting performed from the level of the
renal arteries to the iliac bifurcation; for other than rupture
(eg, for aneurysm, pseudoaneurysm, dissection, penetrating
ulcer)

Endovascular repair of infrarenal aorta and/or iliac artery(ies) ♦ 34704 N 66 B

by deployment of an aorto-uni-iliac endograft including / .9 u
pre-procedure sizing and device selection, all nonselective A5 n
catheterization(s), all associated radiological supervision and
interpretation, all endograft extension(s) placed in the aorta dl
from the level of the renal arteries to the iliac bifurcation, e
and all angioplasty/stenting performed from the level of the d
renal arteries to the iliac bifurcation; for rupture including
temporary aortic and/or iliac balloon occlusion, when
performed (eg, for aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, traumatic disruption)

Endovascular repair of infrarenal aorta and/or iliac artery(ies) ♦ 34705 N 44 B
by deployment of an aorto-bi-iliac endograft including / .3 u
pre-procedure sizing and device selection, all nonselective A4 n
catheterization(s), all associated radiological supervision and dl
interpretation, all endograft extension(s) placed in the aorta e
from the level of the renal arteries to the iliac bifurcation, d
and all angioplasty/stenting performed from the level of the
renal arteries to the iliac bifurcation; for other than rupture
(eg, for aneurysm, pseudoaneurysm, dissection, penetrating
ulcer)

Endovascular repair of infrarenal aorta and/or iliac artery(ies) ♦ 34706 N 66 B
by deployment of an aorto-bi-iliac endograft including / .7 u
pre-procedure sizing and device selection, all nonselective A4 n
catheterization(s), all associated radiological supervision and dl
interpretation, all endograft extension(s) placed in the aorta e
from the level of the renal arteries to the iliac bifurcation, d
and all angioplasty/stenting performed from the level of the
renal arteries to the iliac bifurcation; for rupture including
temporary aortic and/or iliac balloon occlusion, when
performed (eg, for aneurysm, pseudoaneurysm, dissection,
penetrating ulcer, traumatic disruption)

Endovascular repair of iliac artery by deployment of an ♦ 34707 N 33 B
ilio-iliac tube endograft including pre-procedure sizing and / .3 u
device selection, all nonselective catheterization(s), all A1 n
associated radiological supervision and interpretation, and all dl
endograft extension(s) proximally to the aortic bifurcation e
and distally to the iliac bifurcation, and treatment zone d
angioplasty/stenting, when performed, unilateral; for other
than rupture (eg, for aneurysm, pseudoaneurysm, dissection,
arteriovenous malformation)

Endovascular repair of iliac artery by deployment of an ♦ 34708 N 53 B

ilio-iliac tube endograft including pre-procedure sizing and / .6 u
device selection, all nonselective catheterization(s), all A1 n
associated radiological supervision and interpretation, and all
endograft extension(s) proximally to the aortic bifurcation dl
and distally to the iliac bifurcation, and treatment zone e
angioplasty/stenting, when performed, unilateral; for d
rupture including temporary aortic and/or iliac balloon
occlusion, when performed (eg, for aneurysm,
pseudoaneurysm, dissection, arteriovenous malformation,
traumatic disruption)

Endovascular placement of iliac artery occlusion device (List N 6. B
separately in addition to code for primary procedure) / 06 u
A n
dl
♦ 34808 e
d

Revascularization, endovascular, open or percutaneous, 37226 5 15 N
femoral, popliteal artery(s), unilateral; with transluminal 1 .2 /
stent placement(s), includes angioplasty within the same 9 5 A
vessel, when performed 3

Placement of extension prosthesis(es) distal to the common N 9. B
iliac artery(ies) or proximal to the renal artery(ies) for / 38 u
endovascular repair of infrarenal abdominal aortic or iliac A n
aneurysm, false aneurysm, dissection, penetrating ulcer, dl
including pre-procedure sizing and device selection, all ♦ 34709 e
nonselective catheterization(s), all associated radiological d
supervision and interpretation, and treatment zone
angioplasty/stenting, when performed, per vessel treated
(List separately in addition to code for primary procedure)

Delayed placement of distal or proximal extension prosthesis ♦ 34710 N 23 B
for endovascular repair of infrarenal abdominal aortic or iliac / .2 u
aneurysm, false aneurysm, dissection, endoleak, or A5 n
endograft migration, including pre-procedure sizing and dl
device selection, all nonselective catheterization(s), all e
associated radiological supervision and interpretation, and d
treatment zone angioplasty/stenting, when performed;
initial vessel treated

Delayed placement of distal or proximal extension prosthesis N 8. B
for endovascular repair of infrarenal abdominal aortic or iliac ♦ 34711 / 66 u
aneurysm, false aneurysm, dissection, endoleak, or A n

endograft migration, including pre-procedure sizing and dl
device selection, all nonselective catheterization(s), all e
associated radiological supervision and interpretation, and d
treatment zone angioplasty/stenting, when performed; each
additional vessel treated (List separately in addition to code
for primary procedure)

Transcatheter delivery of enhanced fixation device(s) to the ♦ 34712 N 19 B
endograft (eg, anchor, screw, tack) and all associated / .8 u
radiological supervision and interpretation A7 n
dl
e
d

Percutaneous access and closure of femoral artery for 34713 N 3. B
delivery of endograft through a large sheath (12 French or / 74 u
larger), including ultrasound guidance, when performed, A n
unilateral (List separately in addition to code for primary dl
procedure) e
d

Open femoral artery exposure with creation of conduit for 34714 N 7. B
delivery of endovascular prosthesis or for establishment of / 85 u
cardiopulmonary bypass, by groin incision, unilateral (List A n
separately in addition to code for primary procedure) dl
e
d

Open axillary/subclavian artery exposure for delivery of 34715 N 8. B
endovascular prosthesis by infraclavicular or supraclavicular / 77 u
incision, unilateral (List separately in addition to code for A n
primary procedure) dl
e
d

Open axillary/subclavian artery exposure with creation of 34716 N 10 B
conduit for delivery of endovascular prosthesis or for / .8 u
establishment of cardiopulmonary bypass, by infraclavicular A9 n
or supraclavicular incision, unilateral (List separately in dl
addition to code for primary procedure) e
d

Open femoral artery exposure for delivery of endovascular N 6. N
prosthesis, by groin incision, unilateral (List separately in / 02 /
addition to code for primary procedure) A A

♦ 34812

Open iliac artery exposure for delivery of endovascular ♦ 34820 N 10 N
prosthesis or iliac occlusion during endovascular therapy, by / .2 /
abdominal or retroperitoneal incision, unilateral (List A7 A
separately in addition to code for primary procedure) N 11 N
/ .7 /
Open iliac artery exposure with creation of conduit for A8 A
delivery of endovascular prosthesis or for establishment of
cardiopulmonary bypass, by abdominal or retroperitoneal ♦ 34833
incision, unilateral (List separately in addition to code for
primary procedure)

Open brachial artery exposure for delivery of endovascular N 3. N
prosthesis, unilateral (List separately in addition to code for / 79 /
primary procedure) A A

♦ 34834

Ultrasound guided compression repair of arterial 7 5
pseudoaneurysm or arteriovenous fistulae (includes 6 7 2.
diagnostic ultrasound evaluation, compression of lesion and 9 2 78
imaging) 3 2
6

Injection procedures (eg, thrombin) for percutaneous 36002 5 7 N 0.
treatment of extremity pseudoaneurysm 1 3. 6 / 92
8 07 9 A
1 4
2

Endovascular repair of iliac artery bifurcation (eg, aneurysm, ♦ 0254T N 0. B
pseudoaneurysm, arteriovenous malformation, trauma) / 00 u
using bifurcated endoprosthesis from the common iliac A n
artery into both the external and internal iliac artery, dl
unilateral; e

d

Transcatheter placement of an intravascular stent(s) (except 37236 5 13 N
lower extremity artery(s) for occlusive disease, cervical 1 .0 /
carotid, extracranial vertebral or intrathoracic carotid, 9 0 A
intracranial, or coronary), open or percutaneous, including 3
radiological supervision and interpretation and including all
angioplasty within the same vessel, when performed; initial
artery

♦ Inpatient-Only Procedure Add-on Code

CODING INSTRUCTIONS:
573. There are new codes describing EVAR and iliac aneurysm endograft procedures for
2018. There are no changes to the existing FEVAR or TEVAR base codes.
574. Surgical codes 34800-34806, 34825, 34826, and 34900, along with S&I codes 0255T,
75952, 75953, 75954, and 93982, are deleted in 2018. There are sixteen new CPT codes
(34701-34716) to describe EVAR and iliac endograft procedures.
575. The term "endograft" is interchangeable with stent graft, endovascular graft, covered
stent, and endoprosthesis. An "extension" can be any covered stent.
576. Extensions, fixation devices, percutaneous access and closure of femoral artery for
large sheaths (12 French or larger), and some surgical access codes are new for 2018
and apply to all endovascular stent graft procedures (including existing EVAR, FEVAR,
and TEVAR).
577. Codes 34707 and 34708 describe repair of an iliac aneurysm, pseudoaneurysm,
dissection, arteriovenous fistula or malformation, and trauma to the iliac arteries using
an ilio-iliac endograft, not for the treatment of atherosclerotic vascular disease or the
iliac component of an abdominal aortic aneurysm stent graft when treatment occurs at
the same time.
578. Codes 34707 and 34708 describe placement of a "tube endoprosthesis" or stent graft
in the iliac artery.
579. Codes 34812, 34820, 34833, and 34834 are revised in 2018 and are now add-on codes.
Report the code twice if done bilaterally (do not append a -50 modifier, as these are
add-on codes).
580. Non-selective catheter placement codes (36140, 36200) are bundled with iliac stent
graft procedures (34707, 34708). Selective catheter placement codes (36245, 36246,

36247) are bundled with bifurcated iliac stent graft code 0254T.
581. Do code for intravascular ultrasound performed at the time of endovascular aneurysm

repair (before or after deployment of the stent graft) with codes 37252 and 37253.
582. Do code for angioplasty or stent placement to treat a stenotic or dissected segment of

vessel not treated by the stent graft (e.g., outside the stent graft deployment vessel). If
the stent graft extends into the external iliac, do not code for angioplasty or stent
placement, even if for dissection; it is bundled.
583. Do code for angioplasty or stent placement to treat a complication of a stent graft
placement (e.g., dissection or displaced plaque above or below stent graft deployment
vessel). Lower extremity revascularization codes 37220-37235, peripheral angioplasty
codes 37246-37247, and stent placement codes 37236-37237 include both open and
percutaneous approaches.
584. Do code separately for non-target vessel embolization of the ipsilateral internal iliac
artery (37242 and 36245 as documented) when the common iliac stent graft crosses
over the normal internal iliac origin (this prevents endoleak). This embolization is
allowed to be coded, as it is not part of the primary abnormality being treated; it is a
"bystander" that can result in delayed endoleak if not embolized at this session.
585. If an internal iliac aneurysm is treated with coil embolization and stent graft placement
across the internal iliac artery origin, we recommend only coding a single procedure (the
embolization). This is similar to using an Enterprise stent to facilitate intracranial coil
embolization of a wide mouthed aneurysm.
586. The common iliac and external iliac arteries are considered to be separate vessels for
coding purposes. The external iliac and common femoral arteries are also considered
separate vessels for intervention, however, are the same level of contralateral catheter
selectivity. Treat as one procedure if the lesion treated is a "bridging" lesion between
the two vessels. For ilio-iliac stent graft placement to treat non-ruptured aneurysm,
pseudoaneurysm, AVM, dissection, or trauma, code 34707 is usually used only once per
side. Use code 34707-50 if isolated bilateral iliac aneurysms are treated with ilio-iliac
stent grafts. These are inpatient-only (status indicator C) procedures for Medicare.
When treated for acute rupture, use code 34708. When bilateral iliac aneurysms are
treated with an aorto-bi-iliac stent graft, use codes 34705/34706. When a unilateral iliac
aneurysm is treated with an aorto-uni-iliac device, use codes 34703/34704.
587. Do not code for roadmapping, guiding shots, or other contrast injection during
intervention. Angiography of the aorta, iliac, and run-off vessels is included in iliac
aneurysm treatment codes.
588. Do not code for follow-up angiography post intervention, as it is included in the
endovascular codes.
589. Do not code angioplasty if done merely to pre-dilate a lesion for subsequent stent graft
placement.
590. Do not code angioplasty to further dilate or completely deploy a newly placed stent

graft.
591. Do not code angioplasty if intent of procedure was to place a stent graft.
592. Do not code angioplasty or stent placement for any balloon angioplasty or stent

placement in the zone of the iliac stent graft placement.
593. For popliteal and femoral artery aneurysms treated by stent graft technique, consider

use of code 37236. Use code 37236 for stent graft placement in upper extremity, lower
extremity, and visceral vessels to treat aneurysm, pseudoaneurysm, trauma, or AVM.
594. Do not code iliac stent placement (37221) if the stent graft treats both an aneurysm
and a stenosis with the same device. Use code 34707 or 34708.
595. Code stent placement (37221-59) if separate stent placement to treat a stenosis and a
separate stent graft placement (34707, 34708) to treat a separate and distinct iliac
aneurysm is performed in two separate iliac arteries (e.g., common iliac aneurysm and
external iliac stenosis).
596. Do not report code 37221 with code 0254T for treatment on the ipsilateral side.
597. Do use stent placement codes (37221, 37223, 37226, or 37227) for stent graft
placement in an iliac or femoral/popliteal artery to treat stenosis.
598. Stent graft placements for aneurysm, pseudoaneurysm, trauma, dissection, or AVM of
the aorta and iliac arteries are inpatient-only, status indicator C procedures for
Medicare patients.
599. Do not code angioplasty for any balloon angioplasty in the treatment zone of aortic or
iliac stent graft placement. If during a planned angioplasty or stent placement for
stenosis the vessel ruptured, requiring an iliac stent graft placement, the iliac stent graft
deployment is coded for iliac endograft for rupture (34708). This is a new guideline for
2018.
600. Do use code 34708 to describe iliac stent graft placement across a ruptured iliac artery
after initial failed angioplasty or stent to treat a stenosis.
601. If an arterial exposure is performed to create a conduit for delivery of an endovascular
prosthesis, it may be additionally reported with code 34714 (femoral), 34716 (iliac), or
34833 (axillary/subclavian). These codes may be reported with codes 33880-33886,
34701-34708, 34841-34848, and 0254T (EVAR, FEVAR, TEVAR, and iliac endograft
procedures).
602. Code 0254T describes placement of a specialized bifurcated iliac stent graft (e.g., Cook
Zenith Branch Iliac Endovascular Graft) for treatment of iliac bifurcation aneurysm,
pseudoaneurysm, AVM, or trauma. This requires placement of the stent graft device
from the common iliac artery into both the internal and external iliac arteries and
bundles the imaging, S&I, and selective catheter placements related to the procedure.
603. If a stent graft is used as a periscope (extending from the internal iliac artery into the
distal external iliac artery), report code 37236.
604. "With rupture" code 34708 is reported when the patient must be emergently taken to

the lab or operating room for active bleeding to treat the iliac artery.
605. Report code 49000 for decompressive laparotomy for compartment syndrome when

performed at the same time as repair of an iliac artery rupture with ilio-iliac endograft.
606. Temporary occlusion balloon to tamponade a stop active vascular hemorrhage in a

patient with aneurysm rupture is bundled.
607. A device that has an aortic component, a unilateral single iliac limb, and a contralateral

"double" iliac limb (that extends into both the external and internal iliac arteries) is
reported with the combination of codes 34705 and 0254T for non-ruptured.

EXAMPLE(S):

1) Isolated aneurysm of the distal left common iliac artery was discovered on prior angiography.
Under sedation, percutaneous access into the left groin is achieved, and wire and sheath are
placed into the aorta. The 14 French access is "pre" closed with a closure device. Using
fluoroscopy and roadmapping, an iliac stent graft (34707) is delivered to completely cover the
aneurysm. A 12 mm x 40 mm balloon is inflated to seal the proximal and distal aspects.
Follow-up angiography (included) reveals an excellent result. Closure device is deployed (34713).

2) Patient with angiography from outside hospital has a proximal right common iliac artery
aneurysm 4 cm in size and a 70% stenosis of the distal right external iliac artery. The native
external iliac is 8 mm in size. Under sedation, the right groin is opened. Arteriotomy is made
(34812), and the wire/sheath combination is directed into the aorta through the stenosis and
iliac aneurysm using fluoroscopy. Due to a severe external iliac stenosis, 8 mm PTA (37220) is
performed in the more distal external iliac artery (outside the stent graft deployment zone). This
results in a severe dissection requiring placement of a 10 mm x 20 mm external iliac stent (add
37221-59, delete 37220). A stent graft device is then delivered to cover the separate common
iliac artery aneurysm (34707). No endoleaks, thrombosis, or dissection noted on follow-up
injection. The right groin is then closed. (This is an inpatient-only procedure for Medicare.)