CPT code 34716 is used for procedures involving the open exposure of the axillary or subclavian artery for surgical intervention.
CPT code 34716 is used to describe the surgical procedure involving the open exposure of the axillary or subclavian artery for the purpose of conduit creation. This procedure is typically performed to facilitate vascular access or to prepare for further vascular interventions. The axillary and subclavian arteries are major blood vessels located in the upper chest and shoulder area, and this code indicates that the surgeon is making an incision to directly access these arteries, often to insert a graft or other conduit to improve blood flow or to connect to another vascular structure. This code is part of the broader category of vascular surgery procedures and is essential for accurate billing and documentation in healthcare settings.
For CPT code 34716, which involves open axillary/subclavian artery exposure, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their uses:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should clearly indicate the reason for the reduction.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
6. Modifier 66 - Surgical Team: Apply this modifier when a complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure is repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician than the one who originally performed it.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier when a patient requires a return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Apply this modifier when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when an assistant surgeon is required on a limited basis.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
14. Modifier 99 - Multiple Modifiers: Use this modifier when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to ensure accurate billing and reimbursement.
CPT code 34716 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) for the region in which the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each year, the Centers for Medicare & Medicaid Services (CMS) updates the MPFS, which includes the relative value units (RVUs) assigned to each CPT code, reflecting the resources required to perform the service.
To determine if CPT code 34716 is reimbursed by Medicare, healthcare providers should first verify its status on the current MPFS. If the code is listed, it indicates that Medicare recognizes the service for reimbursement, subject to any specific coverage policies or limitations.
Additionally, the MACs, which are private organizations contracted by CMS, play a crucial role in processing Medicare claims and establishing local coverage determinations (LCDs). These LCDs can affect whether a particular CPT code, such as 34716, is reimbursed in a specific geographic area. Providers should consult their regional MAC for any additional guidelines or requirements that may impact reimbursement for this code.
In summary, while CPT code 34716 may be eligible for Medicare reimbursement, providers must confirm its inclusion in the MPFS and adhere to any regional MAC policies to ensure proper billing and payment.
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