CPT code 34842 is used for a procedure involving the placement of two endovascular grafts in the visceral aorta to treat aneurysms or other conditions.
CPT code 34842 is used to describe a specific endovascular procedure involving the placement of two grafts within the visceral aorta. This code is typically utilized when a healthcare provider performs a minimally invasive surgery to repair or reinforce the aorta, which is the main artery carrying blood from the heart to the rest of the body. The procedure involves inserting grafts, which are tube-like structures, to support or replace weakened sections of the aorta, particularly in the area where it supplies blood to the abdominal organs. This code is crucial for accurate billing and documentation of the procedure in the healthcare revenue cycle.
For CPT code 34842, which involves endovascular procedures, the following modifiers may be applicable:
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 additional work that was not anticipated.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier is used to indicate that the procedure was bilateral.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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): If two surgeons are required to perform the procedure, this modifier indicates that each surgeon is performing a distinct part of the procedure.
7. Modifier 66 (Surgical Team): This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician.
9. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician.
10. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier 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 modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.
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 34842 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) in your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the final decision on whether CPT code 34842 is reimbursed, and at what rate, can vary depending on the local coverage determinations (LCDs) established by the MAC.
These contractors have the authority to interpret national policies and create region-specific guidelines, which can affect the reimbursement status of certain procedures. Therefore, it is crucial for healthcare providers to consult their local MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 34842.
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 specific codes like 34842, 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.
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