Ask Dr. Z

Patient previously treated with infrarenal aortic endograft and followed by TEVAR for ruptured thoracic aortic aneurysm. He now returns because aorta has degenerated between the thoracic endograft and the infrarenal aortic endograft to a max diameter of 7 cm thoracoabdominal aortic aneurysm. Patient is taken to surgery for FEVAR for repair of visceral aorta with stents into celiac, SMA left, and right renal (which is CPT 34844). Also thoracic aneurysm repaired with Zenith graft deployed with adequate overlap of existing thoracic graft and the new fenestrated endograft. What coding can the thoracic graft get? Technically it's a delayed distal extension of the TEVAR 33886 or proximal extension of FEVAR, which there is no coding as it's bundled into 34844. Or the other possibility is a new TEVAR of 33881 not covering the subclavian. He did treat two different problems, so I feel additional coding is warranted, but wanted expert advice on the correct way to go about it. There is no bundling issue with either scenario.