CPT code 43195 is a medical billing code for a rigid esophagoscopy procedure using a balloon to treat esophageal conditions.
CPT code 43195 is used to describe a procedure involving a rigid esophagoscopy with the use of a balloon. This procedure typically involves the insertion of a rigid endoscope into the esophagus to visualize the esophageal lining and potentially treat conditions such as strictures or obstructions. The balloon component indicates that a balloon dilation technique is employed during the procedure to widen narrowed areas of the esophagus, facilitating better passage and improving patient outcomes.
For CPT code 43195 (Esophagoscopy rigid balloon), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that necessitate additional time and effort.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically in cases where the technical component is billed separately.
3. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but had to be 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure was repeated by a different physician on the same day.
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: Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was 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: Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier 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 these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 43195 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, reimbursement for CPT code 43195 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) in your region. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding reimbursement for CPT code 43195.
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