CPT code 34812 is used for procedures involving the open exposure of the femoral artery, often related to vascular surgeries.
CPT code 34812 is used to describe the procedure of open femoral artery exposure. This code is typically utilized in the context of endovascular repair of abdominal aortic aneurysms or other vascular procedures where access to the femoral artery is necessary. The procedure involves surgically exposing the femoral artery to allow for the insertion of catheters or other instruments needed for the main procedure. This code is crucial for accurate billing and documentation, ensuring that healthcare providers are reimbursed for the additional work involved in accessing the artery.
For CPT code 34812, which involves open femoral artery exposure, 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 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. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly relevant if the procedure is performed in a different session or site.
4. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 66 - Surgical Team: Applied when a complex procedure requires a surgical team, indicating that multiple professionals are involved in the surgery.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Applied when the procedure is repeated by a different physician on the same day.
8. 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 if the patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Utilized when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Applied when an assistant surgeon is required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary, and a qualified resident is not available.
These modifiers help provide additional context to the procedure performed, ensuring accurate billing and reimbursement. It is crucial to select the appropriate modifier to reflect the specific circumstances of the procedure accurately.
CPT code 34812 is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the payment rates for services covered under Medicare Part B, including those associated with CPT codes. To ascertain if CPT code 34812 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage policies, including any local coverage determinations (LCDs) that might affect the reimbursement of CPT code 34812. Providers should check with their respective MAC to ensure compliance with any regional policies or documentation requirements that could impact reimbursement.
In summary, while CPT code 34812 can be reimbursed by Medicare, it is essential for healthcare providers to verify its status on the MPFS and consult with their MAC for any additional requirements or restrictions.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 34812, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
