CPT code 43116 is for the partial removal of the esophagus, a procedure often used to treat esophageal conditions.
CPT code 43116 is for the partial removal of the esophagus, a surgical procedure where a portion of the esophagus is excised. This procedure may be performed to treat conditions such as esophageal cancer, severe gastroesophageal reflux disease (GERD), or other esophageal disorders. The code specifically indicates that only a part of the esophagus is removed, rather than the entire organ, which would be represented by a different code.
For CPT code 43116 (Partial removal of esophagus), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services
- Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure
- Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons
- Applied 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 requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Indicates that a procedure or service was repeated by the same physician subsequent to the original procedure.
9. Modifier 77 - Repeat Procedure by Another Physician
- Indicates that a procedure or service was repeated by another physician subsequent to the original procedure.
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 patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon
- Applied when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43116 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for the provider's region and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). Providers should consult their MAC for specific coverage and payment information related to CPT 43116.
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