CPT code 34805 is used for the procedure involving the repair of an abdominal aortic aneurysm with a long tube endograft.
CPT code 34805 is used to describe the endovascular repair of an abdominal aortic aneurysm using a long tube endograft. This procedure involves the placement of a stent graft within the aorta to reinforce the weakened section of the artery wall, thereby preventing rupture. The "long tube" refers to the type of endograft used, which is specifically designed to extend over a longer segment of the aorta, providing additional support and coverage. This minimally invasive technique is often preferred over open surgery due to its reduced recovery time and lower risk of complications.
For CPT code 34805, which pertains to endovascular repair procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session by the same provider.
3. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Applied if the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Applied when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
7. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician subsequent to the original procedure.
8. Modifier 77 - Repeat Procedure by Another Physician: Applied when a procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
10. 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.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required.
13. 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 surgeon.
14. Modifier 99 - Multiple Modifiers: Applied when two or more modifiers are necessary to describe the service provided.
These modifiers help in accurately representing the circumstances under which the procedure was performed, ensuring proper billing and reimbursement. It is crucial to review the specific payer guidelines as they may have unique requirements for modifier usage.
CPT code 34805 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting local coverage determinations, which can influence whether a particular service, such as that described by CPT code 34805, is reimbursed in a specific region. Therefore, healthcare providers should consult their local MAC for detailed information on coverage and reimbursement for this CPT code.
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