DEVICES
Covered Graft
Question: What is the difference between a covered graft and an endoprosthesis?
Answer: From a coding perspective, there is no difference. CPT® guidelines specify the terms endovascular graft, endoprosthesis, endograft and stentgraft all refer to a covered graft.
Drug-coated vs Drug-eluting
Question: What is the difference between a drug-coated stent and a drug-eluting stent?
Answer: A drug-coated stent is a peripheral or coronary stent which is coated with a blood thinning agent such as heparin to help reduce the risk of blood clot formation in the stent.
A drug-eluting stent (DES) is a vascular stent which is covered with medication that is slowly released (eluted) to help prevent restenosis/re-narrowing of an affected vessel due to scar tissue or fibrosis. The types of drugs used for DES include paclitaxel, everolimus and sirolimus. There are only a few FDA-approved DES, and they are currently used for coronary arteries.
HCPCS code for EXCLUDER® Endoprosthesis
Question: What is the appropriate HCPCS code (C code) for the GORE® EXCLUDER® endoprosthesis used in the EVAR procedure?
Answer: According to the Outpatient Prospective Payment System (OPPS), C codes are used to report devices for certain procedures performed in the outpatient hospital setting in conjunction with the appropriate CPT® procedure code. CMS classifies EVAR as an inpatient only procedure, and therefore devices typically used in this procedure would not be reported with C codes. So, there is no C code for the GORE® EXCLUDER® endoprosthesis used in the EVAR procedure.
HCPCS code for TBE® Endoprosthesis
Question: What is the appropriate HCPCS code (C code) for the GORE® TBE® endoprosthesis used in the TEVAR procedure?
Answer: According to the Outpatient Prospective Payment System (OPPS), C codes are used to report devices for certain procedures performed in the outpatient hospital setting in conjunction with the appropriate CPT® procedure code. CMS classifies TEVAR as an inpatient only procedure, and therefore devices typically used in this procedure would not be reported with C codes. So, there is no C code for the GORE® TBE® endoprosthesis used in the TEVAR procedure.
