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Official Description

Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; each additional vessel treated (List separately in addition to code for primary procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 34711 refers to the delayed placement of a distal or proximal extension prosthesis following an endovascular repair procedure for specific vascular conditions. This procedure is indicated in cases where there is a need to address complications such as an endoleak, endograft migration, or other issues related to infrarenal abdominal aortic or iliac aneurysms, false aneurysms, or dissections. The term 'delayed placement' signifies that this intervention occurs after the initial endovascular repair has been performed, typically when complications arise that necessitate further intervention to ensure the integrity and functionality of the vascular repair. The procedure involves accessing the femoral arteries, utilizing fluoroscopic guidance to navigate catheters and wires to the aorta, and deploying extension grafts to reinforce or repair the existing endograft. This complex intervention requires careful planning, including pre-procedure sizing and device selection, as well as comprehensive radiological supervision and interpretation to ensure successful outcomes. The procedure also includes angioplasty or stenting of the treatment zone when necessary, and it is important to note that each additional vessel treated during this procedure is reported separately using this code in conjunction with the primary procedure code 34710.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 34711 is indicated for the following conditions:

  • Infrarenal Abdominal Aortic Aneurysm - A localized enlargement of the abdominal aorta that occurs below the renal arteries.
  • Iliac Aneurysm - An aneurysm occurring in the iliac arteries, which are the major blood vessels that supply blood to the pelvis and legs.
  • False Aneurysm - A condition where there is a breach in the arterial wall leading to a hematoma that communicates with the arterial lumen.
  • Dissection - A serious condition in which there is a tear in the artery wall, allowing blood to flow between the layers of the wall.
  • Endoleak - A complication where blood leaks into the aneurysm sac after an endovascular repair, potentially leading to aneurysm growth.
  • Endograft Migration - The movement of the endovascular graft from its original position, which can compromise the repair.

2. Procedure

The procedure for CPT® Code 34711 involves several critical steps to ensure successful placement of the extension prosthesis:

  • Step 1: Accessing the Femoral Artery - The procedure begins with accessing the ipsilateral femoral artery through a skin incision or a percutaneous needle puncture. This access point is crucial for introducing the necessary catheters and devices into the vascular system.
  • Step 2: Fluoroscopic Guidance - Under fluoroscopic guidance, a stiff wire is advanced into the aorta. This wire serves as a guide for the subsequent catheter placement. A catheter is then threaded over the wire, and an occlusion balloon is prepared for deployment in case of hemodynamic instability during the procedure.
  • Step 3: Contralateral Femoral Access - The contralateral femoral artery is accessed similarly, and a flush catheter is advanced to the aorta to facilitate angiography. This step is essential for visualizing the vascular anatomy and identifying any issues with the existing endograft.
  • Step 4: Angiography and Treatment Planning - After performing angiography, the physician assesses the situation to identify any problems or failures with the endovascular stent. Based on these findings, a treatment plan is developed to address the identified issues.
  • Step 5: Limb Extension Placement - For limb extension, a sheath is introduced into the common iliac artery(ies) in a retrograde manner. A guidewire is then inserted through the sheath to the common iliac artery(ies), followed by threading a delivery catheter over the guidewire to the midsection of the existing endograft.
  • Step 6: Deployment of the Extension Graft - The extension graft is deployed through the delivery device, ensuring it is fixed within the existing endograft and extended distally to rest above the bifurcation of the internal and external iliac arteries.
  • Step 7: Aortic Cuff Extension - If an aortic cuff extension is required, the prosthesis is introduced over a guidewire and positioned to overlap the proximal end of the main device. A bifurcated cuff may be utilized to ensure adequate blood flow to the branch arteries.
  • Step 8: Balloon Expansion - A low-pressure balloon is introduced to expand all graft-to-graft junctions, ensuring a tight seal between the components of the graft.
  • Step 9: Final Angiography - A final angiography is performed to confirm the correct location, seal, and patency of all graft components, as well as to assess the repair of any endoleaks and the blood flow to branch arteries, including renal, mesenteric, and internal and external iliac vessels.

3. Post-Procedure

Post-procedure care following the placement of a distal or proximal extension prosthesis involves monitoring the patient for any complications that may arise, such as bleeding or infection at the access site. Patients may require imaging studies to ensure the integrity of the graft and to confirm that there are no endoleaks or other complications. Follow-up appointments are essential to assess the patient's recovery and the functionality of the graft. Additionally, the healthcare team will provide instructions regarding activity restrictions and signs of potential complications that the patient should be aware of during the recovery period.

Short Descr DLYD PLMT XTN PROSTH EA ADDL
Medium Descr DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL
Long Descr Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; each additional vessel treated (List separately in addition to code for primary procedure)
Status Code Active Code
Global Days ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE 2

This is an add-on code that must be used in conjunction with one of these primary codes.

34710 MPFS Status: Active Code APC C Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed; initial vessel treated
37222 Addon Code MPFS Status: Active Code APC N ASC N1 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure)
37223 Addon Code MPFS Status: Active Code APC N ASC N1 Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure)
37252 Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure)
37253 Addon Code MPFS Status: Active Code APC N ASC N1 Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; each additional noncoronary vessel (List separately in addition to code for primary procedure)
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2020-01-01 Note AMA guidelines changed.
2018-01-01 Added Code Added.
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