CPT code 34803 is used for a procedure involving the repair of an abdominal aortic aneurysm with a three-part endovascular graft.
CPT code 34803 is used to describe the endovascular repair of an abdominal aortic aneurysm using a modular bifurcated prosthesis. This procedure involves the insertion of a three-piece device through a catheter to reinforce the weakened area of the abdominal aorta, thereby preventing rupture. The code specifically pertains to the use of a bifurcated graft, which is designed to fit the unique anatomy of the patient's aorta and its branching arteries. This minimally invasive technique is often preferred over open surgery due to its reduced recovery time and lower risk of complications.
For CPT code 34803, which pertains to endovascular repair procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier is applicable.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
7. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
9. Modifier 77 - Repeat Procedure by Another Physician: When the procedure is repeated by a different physician, this modifier is used.
10. 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 modifier is used when a patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is applicable.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required on a minimal basis.
14. 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.
15. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate the use of multiple modifiers.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 34803 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for understanding whether a specific CPT code like 34803 is reimbursed and at what rate. The MPFS provides a comprehensive list of services covered by Medicare and the associated payment rates for those services.
However, it's important to note that reimbursement can also be influenced by local policies set by Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of certain procedures, including those represented by CPT code 34803. Therefore, healthcare providers should consult both the MPFS and their respective MAC's guidelines to determine the specific reimbursement details for CPT code 34803.
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