Clinical Context
A 72-year-old male with a 6.2 cm juxtarenal and suprarenal abdominal aortic aneurysm involving the visceral segment (celiac trunk, superior mesenteric artery, and both renal arteries) is evaluated by a vascular surgery and interventional radiology team. The patient has hypertension, chronic obstructive pulmonary disease, and stage 3 chronic kidney disease; he is deemed high risk for open repair. After multidisciplinary discussion and preoperative planning with high-resolution CT angiography and three-dimensional reconstruction, a fenestrated endovascular aortic repair (FEVAR) is scheduled under radiologic guidance.
On the day of service the patient is brought to a hybrid operating room/radiology suite. Under general anesthesia, bilateral femoral arterial access is obtained. Using fluoroscopic and angiographic guidance, the surgeon deploys a custom fenestrated aortic endograft across the visceral aorta to exclude the aneurysm while maintaining perfusion to the celiac, superior mesenteric, and renal arteries. Three additional visceral artery endoprostheses (stents) are then placed through the fenestrations to seal and secure flow into the target vessels. Completion angiography confirms exclusion of the aneurysm sac, patency of visceral branches, and absence of endoleak. The patient is recovered in a monitored setting and admitted for overnight observation with post-procedure imaging and renal function monitoring.
Typical site of service: hybrid operating room or interventional radiology suite within a hospital (inpatient or same-day observation).
Service type: Endovascular fenestrated aortic aneurysm repair with visceral artery stent grafting under radiologic guidance.
Common payors for authorization and claims processing: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | No modifier | Default when no other modifier applies |
22 | Increased procedural services | Use when work or complexity is substantially greater than typical for the procedure (document rationale)
26 | Professional component | Use only if reporting the physician interpretation/technical split is applicable (rare for endovascular procedures billed global)
50 | Bilateral procedure | Use if a bilateral modifier applies to a CPT that supports it (generally not applicable to 34843)
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the procedure
66 | Surgical team | Use when a surgical team is used for complex procedures requiring multiple surgeons
78 | Return to OR for related procedure during postoperative period | Use for unplanned return to the operating room for a related procedure
80 | Assistant surgeon | Use when an assistant at surgery is required and reportable
81 | Minimum assistant surgeon | Use when a minimal assistant surgeon is present
82 | Assistant surgeon (when qualified resident not available) | Use when an assistant is needed but a qualified resident is not available
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when an advanced practice clinician performs part of the service under applicable rules
TC | Technical component | Use only if separating professional and technical components (rare for 34843)
| Taxonomy Code | Specialty | Notes |
|---|
334E00000X | Vascular Surgery | Primary specialty performing complex aortic endovascular repair including fenestrated grafts |
208600000X | Interventional Radiology | Performs image-guided endovascular placement and intra-procedural imaging
207RC0000X | Cardiothoracic Surgery | May participate in complex aortic procedures in hybrid OR settings
208800000X | Diagnostic Radiology | Provides intraoperative imaging support and interpretation
363L00000X | Vascular Medicine | Provides perioperative medical management and follow-up
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
I71.4 | Abdominal aortic aneurysm, ruptured | Ruptured AAA involving the visceral segment may necessitate urgent endovascular repair |
I71.3 | Abdominal aortic aneurysm, without rupture | Elective repair indication for large or symptomatic visceral aortic aneurysms
I72.3 | Aneurysm of artery of upper extremity (not typically related) | Data included for completeness only — not commonly associated with visceral aortic repair
I77.1 | Stricture of artery | May be relevant for complex aortic/visceral arterial pathology requiring endovascular intervention
Z48.89 | Encounter for other specified surgical aftercare | Postoperative care and follow-up visits after endovascular aortic repair
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
34843 | Placement of fenestrated endograft, visceral aorta, with additional visceral artery endoprostheses | Primary procedure described: fenestrated aortic endograft with placement of three visceral artery endoprostheses |
36245 | Selective catheter placement, arterial system; each first order thoracic, abdominal visceral branch or pelvic branch, when performed | Used for selective catheterization of visceral branches (celiac, SMA, renal) during planning or adjunctive catheter work
36247 | Selective catheter placement, arterial system; each additional second order branch, within the same vascular family | Used for additional selective catheterizations of branch vessels during the procedure
75952 | Angiography, vascular; abdominal, aperformed for therapeutic purposes with radiological supervision and interpretation | Used for completion angiography and intra-procedural imaging documentation
33238 | Endovascular stent graft placement (note: example endograft code for context) | Analogous stent-graft placement code; additional visceral artery endoprostheses may be reported with appropriate stent codes per payer guidance
36415 | Collection of venous blood by venipuncture | Routine pre- and post-procedure laboratory sampling
99152 | Moderate sedation services provided by the same physician performing the procedure | Use if moderate sedation is reported by the operating physician (follow payer rules)
99155 | Moderate sedation services provided by a different physician | Use when moderate sedation provided by anesthesia or another physician