CPT code 43112 is a medical billing code for a total esophagectomy with thoracotomy, used to describe a specific surgical procedure.
CPT code 43112 is used to describe a total esophagectomy with thoracotomy. This surgical procedure involves the complete removal of the esophagus, which is the tube that carries food from the throat to the stomach, and it is performed through an incision in the chest (thoracotomy). This code is typically utilized in cases where there is a need to treat conditions such as esophageal cancer or severe esophageal disease.
For CPT code 43112, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 43112 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B.
To ascertain if CPT code 43112 is reimbursed, you would first check the MPFS to see if this specific code is listed and if it has an assigned reimbursement rate. If the code is present in the MPFS, it indicates that Medicare does reimburse for this service, subject to meeting all necessary coverage criteria and documentation requirements.
Additionally, the MAC for your region may have specific guidelines or additional requirements that need to be met for reimbursement. MACs are responsible for processing Medicare claims and can provide further clarification on whether CPT code 43112 is covered and any specific conditions that must be satisfied.
In summary, to determine if CPT code 43112 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any additional requirements or guidelines.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43112. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
