CPT code 34804 is used for a procedure involving the repair of an abdominal aortic aneurysm with one docking limb.
CPT code 34804 is used to describe the endovascular repair of an abdominal aortic aneurysm using a modular bifurcated prosthesis. This procedure involves the insertion of a stent graft through the blood vessels to reinforce the weakened section of the abdominal aorta, thereby preventing rupture. The "1-p part" indicates that this code is specifically for the repair involving one docking limb or one extension piece. This code is typically utilized by healthcare providers to accurately document and bill for this specific type of endovascular procedure.
For CPT code 34804, which involves endovascular repair procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to unusual anatomy or complications during the procedure.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both sides of the body during the same session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This helps indicate that the procedure is part of a series of operations.
4. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 (Discontinued Procedure): Applied when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 (Surgical Team): Applied when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 (Repeat Procedure by Same Physician): Used when the same physician repeats the procedure on the same day.
9. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure is repeated on the same day by a different physician.
10. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Used when a related procedure is performed during the postoperative period due to complications.
11. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
13. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
15. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies, as requirements can vary.
CPT code 34804 is associated with a specific procedure that may be reimbursed by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 34804 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and payment for specific services within their jurisdiction. Therefore, it is essential for healthcare providers to check with their local MAC to confirm if CPT code 34804 is covered and reimbursed, as policies can vary by region.
In summary, while CPT code 34804 may be reimbursed by Medicare, providers must review the MPFS and consult their local MAC to ensure compliance with coverage criteria and to understand the specific reimbursement details.
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