CPT CODES

CPT Code 34843

CPT code 34843 is used for a procedure involving the placement of three endovascular grafts in the visceral aorta.

Table of Contents
What is CPT Code 34843
Does CPT 34843 Need a Modifier?
CPT Code 34843 Medicare Reimbursement
Are You Being Underpaid for 34843 CPT Code?
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What is CPT Code 34843

CPT code 34843 is used to describe a specific endovascular procedure involving the placement of three 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 the use of endovascular techniques, meaning it is performed inside the blood vessels using catheters and imaging guidance, to place three separate grafts that help support the aorta and improve blood flow. This code is essential for accurate billing and documentation of the procedure in the healthcare revenue cycle.

Does CPT 34843 Need a Modifier?

For CPT code 34843, which involves endovascular repair procedures, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:

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 factors such as patient anatomy or complications during the procedure.

2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier indicates 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 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.

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): 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): If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.

9. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure is repeated by a different physician.

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 modifier is used when an unrelated procedure is performed by the same physician during the postoperative period.

12. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.

13. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.

14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This is used when an assistant surgeon is necessary, and a qualified resident is not available.

15. Modifier 99 (Multiple Modifiers): When more than four modifiers are necessary to describe the service, this modifier is used to indicate multiple modifiers.

These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines and documentation requirements when applying these modifiers.

CPT Code 34843 Medicare Reimbursement

CPT code 34843 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) in your specific region. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and it is updated annually to reflect changes in medical practice and the economy.

However, whether CPT code 34843 is reimbursed can also depend on local coverage determinations (LCDs) made by the MACs, which administer Medicare benefits and process claims. These contractors have the authority to establish specific guidelines and criteria for coverage based on regional needs and medical necessity. Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 34843 with their respective MAC to ensure compliance with local policies and to understand any documentation requirements that may affect reimbursement.

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