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The procedure described by CPT® Code 34845 involves the endovascular repair of the visceral aorta and the infrarenal abdominal aorta, which may be necessary due to various conditions such as aneurysms, pseudoaneurysms, dissections, penetrating ulcers, intramural hematomas, or traumatic disruptions. This repair is accomplished using a fenestrated visceral aortic endograft, which is specifically designed with openings (fenestrations) that align with the ostia of the superior mesenteric, celiac, and renal arteries. This design allows for the continued flow of blood into these critical branches while effectively sealing off the damaged area of the aorta. The procedure is initiated with an incision made in the groin to access the femoral artery, through which a trocar is inserted. A guidewire is then advanced through the arterial system into the aorta, allowing for the subsequent placement of the endograft. The endograft is carefully positioned to ensure that it covers the defect in the aorta, with the proximal edge situated above the involved visceral arteries and the distal edge below the defect. The deployment of the endograft is performed under fluoroscopic guidance to ensure accurate placement and to verify that the fenestrations align correctly with the visceral arteries. In addition to the fenestrated endograft, a unibody or modular infrarenal aortic endograft is also utilized to provide comprehensive coverage of the aortic defect. The procedure includes the placement of a visceral artery endoprosthesis, which is a stent that is deployed through the openings in the endograft to maintain patency in the visceral arteries. Following the deployment, angiography is conducted to assess the positioning of the endograft and stents, ensuring there are no complications such as endoleaks. The procedure concludes with the removal of catheters and guidewires, followed by the closure of the incision in the groin.
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The endovascular repair of the visceral aorta and infrarenal abdominal aorta using CPT® Code 34845 is indicated for the following conditions:
The procedure for endovascular repair as described in CPT® Code 34845 involves several critical steps:
Post-procedure care following the endovascular repair using CPT® Code 34845 typically involves monitoring the patient for any immediate complications, such as bleeding or signs of infection at the incision site. Patients may be advised to limit physical activity for a period to allow for proper healing. Follow-up imaging studies may be scheduled to assess the integrity of the endograft and the patency of the visceral arteries. It is essential to monitor for any potential complications, including endoleaks or stent migration, which may require further intervention. The healthcare team will provide specific instructions regarding activity restrictions, medication management, and signs of complications that should prompt immediate medical attention.
| Short Descr | VISC & INFRAREN ABD 1 PROSTH | Medium Descr | VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS | Long Descr | Endovascular repair of visceral aorta and infrarenal abdominal aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal 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.
| 34709 | Addon Code MPFS Status: Active Code APC C Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed, per vessel treated (List separately in addition to code for primary procedure) | 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) | 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) | 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) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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.) | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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