Endovascular Aortic Aneurysm Repair (EVAR)

CPT 34705 · 28.84 wRVU · 90-day global

CPT34705

wRVU28.84

Global90-day

ApproachEndovascular

ComplexityComplex

Add-on / Variant CPTs

34701 wRVU: 23.12 — EVAR, aorto-aortic (tube graft) endoprosthesis
34812 wRVU: 4.03 — Open femoral artery exposure for endovascular procedure (add-on)

Preoperative Diagnosis:

Abdominal aortic aneurysm, [X] cm maximum diameter, anatomically suitable for EVAR

Postoperative Diagnosis:

Same

Procedure Performed:

Endovascular abdominal aortic aneurysm repair (EVAR), [device: Endurant / Excluder / Zenith]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal [/ spinal / MAC with local]

Indications:

The patient is a [age]-year-old [male/female] with a [X]-cm abdominal aortic aneurysm with anatomy suitable for endovascular repair (infrarenal neck [X] mm diameter, [X] mm length, angulation <60 [patient comorbidities / patient preference / favorable anatomy]. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

Both common femoral arteries were accessed without difficulty. The aortic neck measured [X] mm in diameter with [X] mm length and [X°] angulation. Bilateral iliac fixation zones were adequate. The [Endurant / Excluder / Zenith] endograft was deployed with [no / type I / type II] endoleak on completion angiography.

Description of Procedure:

The patient was positioned supine on the angiography table. Bilateral groin cutdowns were performed through longitudinal incisions. The common femoral arteries were dissected and controlled with vessel loops. Systemic heparin [100 units/kg] was administered and ACT confirmed >250 seconds.

Access was obtained with [18-gauge] needles bilaterally and [7 Fr] sheaths placed. A [Lunderquist] stiff wire was positioned in the descending thoracic aorta under fluoroscopic guidance. The main body of the [device] endograft was introduced via the [right / left] femoral sheath and advanced to the level of the renal arteries under fluoroscopic guidance. The renal arteries were marked using contrast angiography with a pigtail catheter.

The main body was deployed with the proximal fixation zone [X] mm below the lowest renal artery. The contralateral limb gate was cannulated from the [left] femoral access, a stiff wire positioned, and the contralateral limb advanced and deployed. The ipsilateral limb was then deployed to the [common iliac / external iliac] artery. Overlap between the main body and limbs was confirmed [≥3 cm].

Completion angiography was performed in [AP / oblique] projection confirming [no endoleak / adequate seal zones / patent renal and hypogastric arteries]. [A type II endoleak from [IMA / lumbar artery] was identified and [embolized / observed].] Sheaths and wires were removed. Common femoral arteriotomies were repaired with running [5-0 Prolene]. Femoral pulses were confirmed. Wounds were closed in layers.

Complications:

None

Specimens:

None

Estimated Blood Loss:

[X] mL

Drains:

None

Disposition:

The patient tolerated the procedure well and was taken to the PACU in stable condition. Follow-up CTA at [1 month / 12 months] was scheduled per EVAR surveillance protocol.

Epic SmartPhrase Version

PREOPERATIVE DIAGNOSIS: AAA, *** cm, EVAR suitable
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: EVAR, *** device
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: ***

INDICATIONS: .PTAGE-year-old .PTSEX with *** cm AAA. Neck *** mm × *** mm, *** angulation. EVAR selected given ***. Consent obtained.

FINDINGS: Bilateral CFA access obtained. Neck *** mm, iliac fixation adequate. Completion angio: no endoleak / type *** endoleak.

PROCEDURE:
Supine on angio table. Bilateral femoral cutdowns. Heparin *** units/kg, ACT >250. Bilateral access, stiff wires in descending thoracic aorta. *** device main body deployed *** mm below lowest renal. Contralateral limb gate cannulated, limb deployed. Ipsilateral limb to ***. Overlap ≥3 cm confirmed. Completion angio: ***. Sheaths removed. Arteriotomies repaired with 5-0 Prolene. Pulses confirmed. Wounds closed.

EBL: *** mL
COMPLICATIONS: None
DISPOSITION: To PACU, CTA follow-up scheduled.

Signed: .ME, .MYDEGREE
.TODAY

Variants

Type II Endoleak: Embolization

A type II endoleak originating from the [inferior mesenteric artery / lumbar artery] was identified on completion angiography. The aneurysm sac pressure was assessed as low-flow. [Percutaneous embolization was performed: the IMA was cannulated via the SMA collateral pathway and coil-embolized.] Alternatively, the type II endoleak was observed given low-flow character and will be reassessed on 1-month CTA.

Charting Tips

Document the proximal seal zone distance from the lowest renal artery. Inadequate neck seal is the most common cause of type I endoleak and late aneurysm rupture. The distance to the renal arteries must be explicitly recorded.
Document completion angiography findings specifically: endoleak type, renal patency, hypogastric patency, and iliac limb positions. A generic 'no endoleak' statement without documenting renal/hypogastric assessment is insufficient.
EVAR requires lifelong surveillance. Document the follow-up imaging plan in the operative note (CTA at 1, 12, and 24 months, then annually). This establishes the surveillance protocol and is a quality metric.

Billing Tips

34705 (EVAR aorto-biiliac, primary, 28.84 wRVU) is the standard code for bifurcated endograft repair of infrarenal AAA. This is the most common EVAR configuration.
34703 (aorto-uniiliac, 25.86 wRVU) applies when a uniiliac device is used (e.g., with contralateral iliac occlusion and femoral-femoral bypass); 34707 (ilio-iliac, 21.72 wRVU) for isolated iliac aneurysm repair.
Repeat/revision EVAR: 34704 (aorto-uniiliac, 43.88 wRVU), 34706 (aorto-biiliac, 43.88 wRVU). These are higher-weighted because revision is more complex. Document prior endograft and nature of reintervention.
Extension limb placement at the same session: 34709 (+6.34 wRVU add-on per extension). Bill once per extension limb deployed. Delayed extension placement uses 34710/34711.
Femoral artery cutdown and closure are bundled; do not separately bill 35226 for femoral repair. Percutaneous access with closure device (Perclose, ProGlide) is bundled.
Completion angiography imaging is bundled into EVAR codes. Do not separately bill 75952 (aortic imaging) when performed as part of the same EVAR procedure.
Global period is 90 days. Post-op CT surveillance for endoleak, routine follow-up, and routine contrast studies are bundled. Endoleak embolization requires modifier -78 (complication) within the global.

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