CPT code 43196 is a medical billing code for esophagoscopy with guide wire dilation, used to describe a specific procedure in healthcare.
CPT code 43196 is used to describe the procedure of esophagoscopy with the placement of a guide wire for dilation. This involves the use of an endoscope to visualize the esophagus while a guide wire is inserted to assist in dilating any strictures or narrowing within the esophagus. This procedure is typically performed to facilitate further interventions or to improve the passage of food and liquids through the esophagus.
For CPT code 43196, which pertains to esophagoscopy with guide wire dilation, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. This could be due to unusual anatomy or complications during the procedure.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically applicable if the procedure involves both a professional and technical component.
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 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: Use this modifier if the patient needs 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: Apply this modifier if an unrelated procedure 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: Use this modifier if 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 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 43196 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 43196. Additionally, MACs can offer guidance on any local coverage determinations or specific billing requirements that may affect reimbursement.
Always consult these resources to ensure accurate and up-to-date information regarding Medicare reimbursement for CPT code 43196.
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