2025 CPT code 34709
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Cardiovascular System - Endovascular Procedures Surgery Feed
Placement of extension prosthesis(es) to repair an infrarenal abdominal aortic or iliac vessel during a primary vascular procedure.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT guidelines for modifier usage.
Medical necessity is established by the presence of an aneurysm, false aneurysm, dissection, or penetrating ulcer in the infrarenal aorta or iliac arteries requiring endovascular repair. The extension prosthesis is medically necessary when the primary endograft is insufficient to treat the entire extent of the pathology.
The physician is responsible for pre-procedural planning, including sizing and selecting the appropriate device. They perform the procedure using imaging guidance (fluoroscopy), including catheterization, angioplasty/stenting as needed, and deployment of the extension prosthesis. Post-procedural imaging is also performed to confirm placement and assess for any complications.
In simple words: This code is used when a doctor adds a tube-like graft to repair a weakened or damaged artery in the belly or pelvis during a main artery repair procedure. This includes the planning, placing the graft, and using imaging to guide the procedure. It's only billed once per artery, even if multiple smaller grafts are added.
This add-on code reports the placement of extension prosthesis(es) that terminate in the internal iliac, external iliac, or common femoral artery(ies), or in the abdominal aorta proximal to the renal artery(ies).The procedure includes pre-procedure sizing and device selection, all nonselective catheterization(s), associated radiological supervision and interpretation, and treatment zone angioplasty/stenting, when performed. It is reported per vessel treated and only once per vessel, regardless of the number of endograft extensions placed.It is used in conjunction with codes 34701, 34702, 34703, 34704, 34705, 34706, 34707, 34708, 34845, 34846, 34847, and 34848.Placement of a docking limb extending into the external iliac artery is not separately reported.
Example 1: A patient presents with an infrarenal abdominal aortic aneurysm.During the endovascular repair using a stent graft (34701), an extension is required to reach a distal portion of the iliac artery. 34709 is reported in addition to 34701., A patient undergoes an endovascular repair of an iliac artery aneurysm (34707). During the procedure, an additional extension is needed to adequately treat the aneurysm. 34709 is reported in addition to 34707., A patient with a ruptured abdominal aortic aneurysm undergoes emergent endovascular repair (34702). The surgeon needs to extend the prosthesis into both iliac arteries, requiring the use of multiple extension grafts.34709 is reported once for each iliac artery, in addition to 34702.
Pre-procedure imaging (angiogram, CT), operative report detailing the placement of the extension prosthesis(es) specifying the location, type of prosthesis, and measurements, intraoperative fluoroscopy images, post-procedure angiography to confirm placement and assess for endoleaks, and pathology reports if tissue was obtained.
** Accurate documentation of the number of vessels treated is crucial.The use of 34709 should only reflect extensions that extend outside the treatment zone defined by the primary procedure codes.Intravascular ultrasound (IVUS) is separately reportable (37252, 37253).
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Vascular Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center