CPT code 34830 is used for the procedure involving the repair of an aortic tube prosthesis through an open surgical approach.
CPT code 34830 is used to describe the surgical procedure for the open repair of an aortic tube prosthesis. This involves the replacement or repair of a section of the aorta, which is the large artery that carries blood from the heart to the rest of the body, using a prosthetic tube. This procedure is typically performed to address conditions such as aneurysms or other forms of aortic disease that compromise the integrity of the aorta. The "open" aspect of the procedure indicates that it is performed through a traditional surgical incision, allowing direct access to the aorta for the placement of the prosthetic material.
For the CPT code 34830, which involves open aortic tube prosthesis repair, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or time.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: If the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient, this modifier is applicable.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
7. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is applicable.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This indicates that a procedure was repeated by a different provider.
10. 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 is used when a patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is crucial to select the appropriate modifier to reflect the specific situation accurately.
The CPT code 34830 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries.
Whether CPT code 34830 is reimbursed by Medicare depends on several factors, including the specific guidelines and coverage determinations set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to make local coverage decisions that can affect reimbursement.
Therefore, it is essential to consult the relevant MAC's policies and the MPFS to determine if CPT code 34830 is reimbursed in your specific case.
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