CPT code 43135 is for the surgical removal of an esophageal pouch, a procedure often related to digestive health issues.
CPT code 43135 is for the surgical procedure involving the removal of an esophageal pouch. This procedure typically addresses conditions such as diverticula or other abnormalities in the esophagus that may cause complications. The code specifically indicates that the pouch, which is an abnormal outpouching of the esophagus, is being surgically excised to alleviate symptoms or prevent further health issues.
For CPT code 43135, 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. This could be due to increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps in indicating that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. This modifier indicates that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 62 (Two Surgeons): When two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure, each surgeon should report their distinct operative work by adding this modifier.
5. Modifier 66 (Surgical Team): Used when a complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel and various types of complex equipment.
6. Modifier 76 (Repeat Procedure by Same Physician): Applied when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. 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.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates that a related procedure was performed during the postoperative period of the initial procedure.
9. 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.
10. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Used when an assistant surgeon is required for a short duration during the procedure.
12. 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.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician provider assisted in the surgery.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43135 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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