CPT code 34820 is used for the procedure involving the open exposure of the iliac artery, typically performed to facilitate vascular access.
CPT code 34820 is used to describe the surgical procedure of open exposure of the iliac artery. This code is typically utilized when a surgeon needs to access the iliac artery, which is a major blood vessel in the pelvis, to perform various interventions such as placing a stent or conducting a bypass. The procedure involves making an incision to directly visualize and work on the artery, ensuring precise and effective treatment. This code is crucial for accurate billing and documentation in the context of vascular surgeries.
For CPT code 34820, which involves open iliac artery exposure, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both iliac arteries during the same surgical session. It indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It helps in indicating that more than one procedure was performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is particularly useful if the procedure is performed in a different session or site.
4. Modifier 62 - Two Surgeons: This modifier is applicable if two surgeons are required to perform the procedure due to its complexity. Each surgeon performs a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This modifier is used when a surgical team is necessary to perform the procedure, indicating that the complexity of the procedure requires multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician needs to repeat the procedure on the same day for the same patient.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if a different physician repeats the procedure on the same day for the same patient.
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: This modifier is used if the patient needs to return 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 34820 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 34820 is listed on the MPFS, it indicates that Medicare has established a payment rate for this service, subject to any applicable conditions or limitations.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and ensuring compliance with Medicare policies in specific geographic areas. Each MAC may have unique local coverage determinations (LCDs) that can affect whether a particular CPT code, such as 34820, is reimbursed. These LCDs can include specific medical necessity criteria, documentation requirements, and other conditions that must be met for reimbursement.
Therefore, to determine if CPT code 34820 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their regional MAC. This ensures that they are aware of any specific requirements or limitations that may impact reimbursement for this code.
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