CPT code 43194 is for the procedure of esophagoscopy with rigid instruments to remove foreign bodies from the esophagus.
CPT code 43194 is for the procedure of esophagoscopy with rigid instrumentation, specifically for the removal of foreign bodies from the esophagus. This code indicates that a healthcare provider has performed an examination of the esophagus using a rigid scope and has successfully extracted an object that was obstructing the esophageal passage.
For CPT code 43194, which pertains to the esophagoscopy procedure for the removal of a foreign body, 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. For example, if the removal of the foreign body is particularly complex or time-consuming.
2. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. For instance, if the procedure was started but not completed due to unforeseen circumstances.
3. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient. For example, if the procedure had to be stopped because of patient instability.
4. 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. For example, if another endoscopic procedure was performed on the same day but was unrelated to the foreign body removal.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: 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. For example, if the foreign body removal had to be repeated due to incomplete removal in the first attempt.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure. For example, if another specialist had to perform the procedure after the initial attempt.
7. 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 patient returns to the operating room for a related procedure during the postoperative period of the initial procedure. For example, if complications arose requiring a return to the operating room for further intervention.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure. For example, if a different issue necessitated another procedure within the postoperative period of the foreign body removal.
9. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure. For example, if the complexity of the foreign body removal necessitated an additional surgeon's assistance.
10. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure. For example, if the procedure required minimal but necessary assistance.
11. 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. For example, in teaching hospitals where residents typically assist but were unavailable.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgery. For example, if a physician assistant was required to assist in the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and appropriate reimbursement.
The CPT code 43194 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of the payment rates for services covered by Medicare, including the CPT code 43194. Additionally, reimbursement can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that area. Therefore, healthcare providers should consult their local MAC for precise information on the reimbursement rates and any specific billing requirements for CPT code 43194.
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