CPT code 36834 is used for the procedure involving the repair of an arteriovenous aneurysm, a condition affecting blood vessels.
CPT code 36834 is used to describe the surgical procedure for repairing an arteriovenous (A-V) aneurysm. An A-V aneurysm is an abnormal bulge in the wall of a blood vessel that occurs at the site of an arteriovenous fistula, which is often created for dialysis access. This code is specifically utilized when a healthcare provider performs a repair to address the aneurysm, ensuring the integrity and functionality of the vascular access. The procedure involves careful surgical intervention to correct the aneurysm, thereby preventing potential complications such as rupture or impaired blood flow.
For CPT code 36834, which pertains to the repair of an arteriovenous (A-V) aneurysm, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body during the same operative session, this modifier should be used to indicate that the procedure was bilateral.
3. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.
4. Modifier 52 - Reduced Services: Use this modifier when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
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. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier should be used. Each surgeon should report their specific portion of the procedure.
7. Modifier 66 - Surgical Team: Use this modifier when a team of surgeons is required to perform the procedure due to its complexity. Documentation should support the necessity of a team approach.
8. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier when a different physician repeats the procedure on the same day.
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 modifier is used when the patient requires a return 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: Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when a minimum assistant surgeon is required for the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier when a non-physician practitioner assists in the surgery.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to ensure accurate billing and reimbursement.
CPT code 36834, which pertains to the repair of an A-V aneurysm, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a specific CPT code is reimbursed. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, and it is updated annually to reflect changes in policy and practice.
To ascertain if CPT code 36834 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) are responsible for processing Medicare claims and can provide guidance on coverage specifics. MACs may have local coverage determinations (LCDs) that affect whether a particular service is reimbursed in their jurisdiction.
Therefore, while CPT code 36834 can be reimbursed by Medicare, providers should verify its status on the MPFS and consult their respective MAC for any local policies that might influence reimbursement.
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