CPT code 34702 is used for reporting endovascular repair of an abdominal aortic aneurysm using a modular bifurcated prosthesis.
CPT code 34702 is used to describe the endovascular repair of an abdominal aortic aneurysm or dissection using a modular bifurcated prosthesis. This procedure involves the placement of a stent graft within the abdominal aorta to reinforce the weakened section of the vessel and prevent rupture. The code specifically refers to the repair that includes the deployment of the endograft and any necessary imaging guidance to ensure proper placement. This code is typically used by vascular surgeons and interventional radiologists when documenting the procedure for billing and insurance purposes.
For CPT code 34702, the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased intensity, time, technical difficulty, or severity of the patient's condition.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the discretion of the physician. This indicates that the service provided was less than what is typically required.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are equally responsible for the procedure.
5. Modifier 66 - Surgical Team: Use this modifier when a team of surgeons is necessary to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician needs to repeat the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician repeats the procedure on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This is used when a patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required to help with the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This is used when more than four modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with payer-specific guidelines and documentation should support the use of any modifier to ensure proper reimbursement.
The CPT code 34702 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 34702 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this service, assuming all other coverage criteria are met.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and providing coverage decisions at the regional level. Each MAC may have specific local coverage determinations (LCDs) that affect whether CPT code 34702 is reimbursed. These determinations can vary based on medical necessity, documentation requirements, and other factors.
Therefore, to ascertain if CPT code 34702 is reimbursed by Medicare, healthcare providers should verify its status on the MPFS and consult with their regional MAC for any specific coverage policies or requirements.
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