CPT code 34802 is used for endovascular repair of an abdominal aortic aneurysm with a two-piece prosthesis.
CPT code 34802 is used to describe the endovascular repair of an abdominal aortic aneurysm using a modular bifurcated prosthesis. This procedure involves the insertion of a two-piece prosthetic device to reinforce the weakened area of the abdominal aorta, which is the large blood vessel that supplies blood to the abdomen, pelvis, and legs. The modular bifurcated prosthesis is designed to fit the specific anatomy of the patient, providing a customized solution to prevent the aneurysm from rupturing. This minimally invasive procedure is typically performed by a vascular surgeon and is an alternative to open surgical repair, offering benefits such as reduced recovery time and lower risk of complications.
For CPT code 34802, which pertains to endovascular repair procedures, the following modifiers may be applicable. These modifiers are used to provide additional information about the performed procedure and ensure accurate billing and reimbursement:
1. Modifier 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body. This modifier indicates that the procedure was performed bilaterally during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier helps in identifying that more than one procedure was carried out.
3. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion. This modifier indicates that the service provided was less than usually required.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This modifier is used to prevent bundling of services that are typically not reported together.
5. Modifier 62 - Two Surgeons: Applied when two surgeons work together as primary surgeons performing distinct parts of a procedure. This modifier indicates that the procedure required the expertise of two surgeons.
6. Modifier 66 - Surgical Team: Used when a complex procedure requires the skills of several physicians, often from different specialties, working together as a team.
7. Modifier 76 - Repeat Procedure by Same Physician: Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician after the original procedure.
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: Indicates that the patient required 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: Used when a procedure performed during the postoperative period is unrelated to the original procedure.
These modifiers help in providing a comprehensive understanding of the circumstances under which the procedure was performed, ensuring accurate documentation and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 34802 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final decision on reimbursement can vary based on local coverage determinations (LCDs) made by the MAC, which may impose specific criteria or documentation requirements for the procedure.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 34802 with their regional MAC to ensure compliance with Medicare's billing and coverage guidelines.
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