How To Use CPT Code 34718

CPT 34718 describes the endovascular repair of the iliac artery using a branched endograft, excluding the placement of an aorto-iliac artery endograft. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 34718?

CPT 34718 is used to describe the endovascular repair of the iliac artery using a branched endograft. This procedure is performed to treat conditions such as aneurysms, pseudoaneurysms, dissections, arteriovenous malformations, and penetrating ulcers. It involves the deployment of an iliac branched endograft, which includes pre-procedure sizing and device selection, selective catheterization of the ipsilateral iliac artery, radiological supervision and interpretation, and the extension of the endograft proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery. If the procedure is performed bilaterally, modifier 50 should be used.

2. Official Description

The official description of CPT code 34718 is: ‘Endovascular repair of iliac artery, not associated with placement of an aorto-iliac artery endograft at the same session, by deployment of an iliac branched endograft, including pre-procedure sizing and device selection, all ipsilateral selective iliac artery catheterization(s), all associated radiological supervision and interpretation, and all endograft extension(s) proximally to the aortic bifurcation and distally in the internal iliac, external iliac, and common femoral artery(ies), and treatment zone angioplasty/stenting, when performed, for other than rupture (eg, for aneurysm, pseudoaneurysm, dissection, arteriovenous malformation, penetrating ulcer), unilateral.’

3. Procedure

1. The provider begins by making an incision in the groin area over the femoral artery on one side of the body.
2. A guidewire is inserted into the femoral artery and advanced to the diseased portion of the common iliac artery.
3. A sheath containing a bifurcated tube device (endograft) is then introduced over the guidewire and positioned with the main stem in the iliac artery and one branch in the external iliac artery and one in the internal iliac artery.
4. If necessary, additional extensions may be added to reach past any defects in the internal and external iliac arteries and to the common femoral artery.
5. The provider may also perform angioplasty or stenting to treat any other issues, such as atherosclerosis or stenosis.
6. Intraoperative angiography is performed to ensure proper blood flow restoration.
7. Finally, all instruments are removed, bleeding is controlled, and the wound is closed.