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The procedure described by CPT® Code 34841 involves the endovascular repair of the visceral aorta, which is a critical component of the abdominal aorta that supplies blood to the organs in the abdominal cavity. This procedure is specifically indicated for various conditions affecting the visceral aorta, including aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions. The use of a fenestrated visceral aortic endograft is essential in this context, as it is designed with openings (fenestrations) that align with the ostia of the superior mesenteric, celiac, and renal arteries, allowing for uninterrupted blood flow to these vital branches during and after the repair. The endovascular approach minimizes the need for large incisions, as it typically involves accessing the aorta through a small incision in the groin over the femoral artery. This method not only enhances recovery times but also reduces the risk of complications associated with more invasive surgical techniques. The procedure includes comprehensive radiological supervision and interpretation, ensuring that the deployment of the endograft is accurately guided and monitored throughout the process.
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Aneurysm - A bulging or dilation in the wall of the aorta that can lead to rupture if not treated.
Pseudoaneurysm - A false aneurysm that occurs when blood leaks out of the artery but is contained by surrounding tissue.
Dissection - A serious condition where there is a tear in the inner layer of the aorta, allowing blood to flow between the layers of the artery wall.
Piercing Ulcer - An ulceration that penetrates the aortic wall, potentially leading to serious complications.
Intramural Hematoma - A collection of blood within the wall of the aorta, which can compromise the integrity of the vessel.
Traumatic Disruption - Damage to the aorta resulting from physical injury, necessitating urgent repair.
Step 1: The procedure begins with the patient being positioned appropriately, and local anesthesia is administered at the site of the incision in the groin over the femoral artery. This access point is crucial for the subsequent steps of the procedure.
Step 2: A trocar is inserted into the femoral artery, allowing for the introduction of a guidewire. The guidewire is carefully advanced through the external and common iliac arteries and into the aorta, navigating to the site of the aortic defect.
Step 3: Once the guidewire is positioned just above the proximal aspect of the defect, a second guidewire and catheter may be introduced to facilitate the deployment of the endograft.
Step 4: An introducer sheath containing the compressed fenestrated aortic endograft is then advanced over the guidewire. The positioning of the endograft is critical, with the proximal edge placed above the involved visceral arteries and the top of the defect, while the distal edge should lie below the bottom of the defect in the aorta.
Step 5: If a second catheter was introduced, it is withdrawn at this stage. The endograft is deployed under fluoroscopic guidance, ensuring that the fenestrations align correctly over the involved visceral vessels.
Step 6: After deploying the aortic portion of the endograft, fluoroscopic verification is performed to confirm adequate coverage of the aortic defect.
Step 7: The introducer sheath is removed, and a balloon catheter is introduced to expand and secure the proximal and distal ends of the prosthesis, ensuring a proper fit within the aorta.
Step 8: Stents are then placed through the ostia of the involved visceral arteries, and a balloon catheter is used to seat these stents securely in place.
Step 9: Following the placement of the stents, the balloon catheter is removed, and a pigtail or side-hole catheter is introduced over the guidewire to perform angiography. This imaging step evaluates the position of the endograft and stents, checks the patency of the superior mesenteric, celiac, and renal arteries, and ensures that there are no endoleaks present.
Step 10: Finally, all catheters and guidewires are removed, and the incision in the groin is closed, completing the procedure.
Post-procedure care involves monitoring the patient for any complications, such as bleeding or signs of infection at the incision site. Patients may be advised to limit physical activity for a specified period to promote healing. Follow-up imaging studies may be scheduled to assess the position and function of the endograft and stents, ensuring that blood flow to the visceral arteries remains unobstructed. Additionally, patients will be educated on signs and symptoms to watch for that may indicate complications, such as abdominal pain or changes in bowel habits, which should prompt immediate medical attention.
| Short Descr | ENDOVASC VISC AORTA 1 GRAFT | Medium Descr | ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT | Long Descr | Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed; including one visceral artery endoprosthesis (superior mesenteric, celiac or renal artery) | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | P2B - Major procedure, cardiovascular-Aneurysm repair | MUE | 1 |
This is a primary code that can be used with these additional add-on codes.
| 34713 | Addon Code MPFS Status: Active Code APC N ASC N1 Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure) | 34714 | Addon Code MPFS Status: Active Code APC N ASC N1 Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34715 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34716 | Addon Code MPFS Status: Active Code APC N ASC N1 Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure) | 34808 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Endovascular placement of iliac artery occlusion device (List separately in addition to code for primary procedure) | 34812 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure) | 34820 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) | 34833 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List separately in addition to code for primary procedure) | 34834 | Addon Code Resequenced Code MPFS Status: Active Code APC C CPT Assistant Article Open brachial artery exposure for delivery of endovascular prosthesis, unilateral (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) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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