CPT code 34831 is used for procedures involving the open repair of an aortoiliac prosthesis, a surgical intervention on major blood vessels.
CPT code 34831 is used to describe the surgical procedure for the open repair of an aortoiliac prosthesis. This procedure involves the surgical correction or replacement of a prosthetic graft that has been previously placed in the aortoiliac region, which includes the aorta and the iliac arteries. The repair is necessary when there are complications such as graft failure, infection, or other issues that compromise the function of the prosthesis. This code is utilized by healthcare providers to accurately document and bill for the specific surgical intervention performed to address these complications.
For the CPT code 34831, which pertains to open aortoiliac prosthetic repair, the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 complications or other factors that increase the complexity of the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was performed.
3. 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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the shared responsibility.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated 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 a 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 performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 34831 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 34831. However, the reimbursement for this specific code can vary based on geographic location and other local policies.
Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations in their respective jurisdictions. They may have specific Local Coverage Determinations (LCDs) that affect whether and how CPT code 34831 is reimbursed. Therefore, healthcare providers should consult the MPFS for the national payment rate and check with their local MAC for any additional guidelines or requirements that might influence reimbursement for this code.
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