This month “In the kNOW” will provide information on endoleaks which occur in the aorta after a previous aneurysm repair. An endoleak happens when blood leaks out of a stent graft and into the aneurysm. These leaks can be a result of a problem with the stent grafts themselves or from vessels that feed the aneurysm sac. This can cause the aneurysm to increase in size and increase the possibility of rupture.
Endoleaks are not uncommon after an aortic aneurysm repair. In fact, they occur in about 25% of endovascular aneurysm repairs (EVARs) or thoracic endovascular aortic repairs (TEVARs). When an endoleak occurs within 30 days of a repair procedure, it is called an early endoleak. Those leaks that occur more than 30 days after repair are termed late or secondary endoleaks.
There are five different types of endoleaks as illustrated below. Here is a brief description of each of them.
Type I-failure of the stent graft or migrationType Ib-the seal at the distal end of the stent graft is not secure
Type IIb-leakage from two or more vessels
Type IV-leakage occurs through the stent graft itself
Type V-aneurysm sac increases in size without evidence of leak, referred to as endotension
Here is the ICD-10-CM coding for each type of endoleak:
Type Ia-T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial
Type Ib-T82.898A Other specified complication of vascular prosthetic devices, implants, and grafts, initial
Type II-I97.89 Other postprocedural complications and disorders of the circulatory system, not elsewhere classified
Type III- T82.310A Breakdown (mechanical) of aortic (bifurcation) graft (replacement), initial
Type IV-T82.330A Leakage of aortic (bifurcation) graft (replacement), initial
Type V-T82.390A Other mechanical complication of aortic (bifurcation) graft (replacement), initial
Type I endoleaks that are not specified as early or late default to being coded as early. Additionally, if type IIa endoleaks are discovered during the initial repair and the patient’s anatomy has led this to be an expected issue, no code for an endoleak should be assigned. Notice that only the Type IV endoleak is coded as “leakage”. This is because the stent graft is too porous and letting blood through. The other endoleaks are complications of the stent graft or, as in the case of Type II endoleaks, other prostprocedural complications.
Endoleaks can be treated in various ways. First, the provider may recommend watchful waiting especially for a Type II endoleak. Monitoring can track if the feeding vessels clot off. If they do not, surgery will be necessary to avoid a rupture. If observation is not indicated, the provider may perform an endovasular treatment. This could include embolization of the feeding vessels, or the use of glue or additional stent grafts to repair the leak. Finally, if endovascular treatment is not suitable, then the provider can perform an open procedure to perform a repair of the leak.
Now you are In the kNOW!!
 Source: https://onlinelibrary.wiley.com/doi/full/10.1002/jmrs.522
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About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
