Payment and Coding Changes you need to know with Open Exposure in EVAR

Payment and Coding Changes you need to know with Open Exposure in EVAR

June 11, 2020

Question:
Does it matter that the open exposure codes are now add-on codes? Does that change payment or coding in any way?

Answer:

Yes, this change has both coding and payment implications. In terms of coding, the open exposure codes can now only be reported with a primary code; the main body EVAR code. If a different provider performs the open exposure, he/she would also have to report as assistant on the EVAR main body code in order to report the add-on exposure code.

From a reimbursement perspective, add-on codes should be paid as 100% of the allowable and are not subject to the multiple procedure payment reduction of 50%. For example, when femoral exposure, 34812, was a primary code, it received a 50 % reduction when performed with an EVAR and when performed bilaterally. As an add-on code, it is paid in full. To avoid a payment reduction, CPT advises that all exposure codes for EVAR be reported with units instead of a 50 modifier when performed bilaterally.

*This response is based on the best information available as of 06/11/20.

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