CPT code 34826 is used for an additional endovascular extension prosthesis procedure, aiding in precise documentation and reimbursement.
CPT code 34826 is used to describe the placement of an additional endovascular extension prosthesis in the treatment of aortic aneurysms. This procedure involves the insertion of a prosthetic device to reinforce or extend the existing endovascular graft, which is used to repair or support the aorta, typically in cases where an aneurysm is present. The code specifically applies when an additional prosthesis is needed beyond the initial graft placement, indicating a more complex intervention to ensure the stability and effectiveness of the repair. This code is crucial for accurate billing and documentation in the context of endovascular surgery.
For CPT code 34826, which pertains to endovascular extension prosthesis procedures, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same 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 identifying that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: This modifier is applied to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to avoid bundling of services that are typically considered inclusive.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure, this modifier indicates that each surgeon performed a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the expertise of a surgical team, indicating that multiple professionals were involved in the procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats the procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated on the same day by a different physician.
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 when a patient requires an unplanned 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 when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers are used to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for the use of these modifiers.
CPT code 34826 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a list of services covered by Medicare and assigns a relative value to each service, which influences reimbursement rates. However, the final decision on whether CPT code 34826 is reimbursed, and at what rate, can vary based on local coverage determinations made by the MAC.
Therefore, it is crucial for healthcare providers to consult the MPFS and their regional MAC guidelines to confirm the reimbursement status and any specific billing requirements for CPT code 34826.
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