CPT code 43192 is for an esophagoscopy with rigid instrument and transoral injection, used to examine and treat esophageal conditions.
CPT code 43192 is for the procedure involving the use of an esophagoscope to perform a rigid transoral injection. This typically involves the insertion of a rigid endoscope through the mouth to visualize the esophagus and administer an injection, often for therapeutic purposes such as treating conditions affecting the esophagus.
For CPT code 43192, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 26 (Professional Component): This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for their expertise and interpretation, not the technical component.
3. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. It indicates that the service provided was less than usually required.
4. Modifier 53 (Discontinued Procedure): This modifier is 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): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used 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): This modifier is 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): This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist provides services as an assistant at surgery.
14. Modifier GC (Service performed in part by a resident under the direction of a teaching physician): This modifier is used when a resident performs a service under the direction of a teaching physician.
15. Modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals): This modifier is used when a physician provides medical direction for multiple anesthesia procedures.
16. Modifier QS (Monitored anesthesia care service): This modifier is used to indicate that monitored anesthesia care was provided.
17. Modifier QX (CRNA service with medical direction by a physician): This modifier is used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
18. Modifier QY (Medical direction of one CRNA by an anesthesiologist): This modifier is used when an anesthesiologist provides medical direction for one CRNA.
19. Modifier QZ (CRNA service without medical direction by a physician): This modifier is used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43192 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and payment may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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