2025 CPT code 34820

Open iliac artery exposure for endovascular prosthesis or occlusion device placement during endovascular therapy.

This is an add-on code and should be reported only when open iliac artery exposure is performed.It should not be reported if the iliac artery can be accessed percutaneously.The code is reported only once per side. For bilateral procedures, report it twice.Modifier 50 should not be used with this code.

Modifiers may be applicable based on the circumstances of the procedure, such as modifier 50 for bilateral procedures (though this is specifically disallowed according to guidelines), or other modifiers indicating specific circumstances of the procedure.

Medical necessity is established by the presence of an iliac artery pathology (aneurysm, occlusion, etc.) requiring endovascular therapy, where the artery's size prevents percutaneous access and necessitates open surgical exposure.

The surgeon is responsible for making the incision, accessing the iliac artery, preparing the artery for device insertion (either a prosthesis or occlusion device), and closing the incision.They must carefully avoid injuring surrounding structures like the ureters.

IMPORTANT This code is used in conjunction with other codes for primary endovascular procedures.For bilateral procedures, the code is reported twice.It should not be reported with codes 33953, 33954, 33959, 33962, 33969, 33984.

In simple words: The doctor makes a small cut in the abdomen or lower back to access the iliac artery (a blood vessel in the pelvis). This is done to place a tube-like device to improve blood flow or a device to block blood flow, as part of a larger procedure to treat a blood vessel problem.This smaller cut and access procedure is billed separately.

This CPT code reports open iliac artery exposure performed via an abdominal or retroperitoneal incision to facilitate the delivery of an endovascular prosthesis or occlusion device during an endovascular therapy procedure.The procedure involves accessing the iliac artery, preparing it for device insertion, and then closing the incision.This code is reported as an add-on code in addition to the primary procedure code.

Example 1: A patient presents with a ruptured iliac artery aneurysm.The surgeon performs an endovascular repair, requiring an open iliac artery exposure (34820) to facilitate endograft deployment.The primary procedure code would be 34708 (endovascular repair of iliac artery for rupture) and 34820 is reported in addition., A patient undergoes an endovascular abdominal aortic aneurysm repair. Due to the small diameter of the iliac artery, an open surgical exposure (34820) is necessary for the endograft placement.The primary procedure would be a code from the 34701-34706 series depending on the specifics of the aneurysm and repair., A patient with an iliac artery occlusion requires placement of an occlusion device. Open surgical exposure (34820) of the iliac artery is required to allow for proper device deployment and this code is reported in addition to the primary procedure code.

Detailed operative notes describing the incision site, approach (abdominal or retroperitoneal), vessel accessed (iliac artery), device deployed (prosthesis or occlusion device), and closure technique.Pre-operative imaging (angiogram) demonstrating the need for open access is also required.

** Consult the most recent CPT codebook and NCCI edits for the most up-to-date information regarding this code.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Specialties:Vascular Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center
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