June 30, 2022
Does it matter that the open exposure codes are now add-on codes? Does that change payment or coding in any way?
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 06/30/22