CPT code 43201 is a medical billing code for an esophagogastroduodenoscopy with submucosal injection.
CPT code 43201 is for an esophagogastroduodenoscopy (EGD) procedure that includes the use of a submucosal injection. This means that during the endoscopic examination of the esophagus, stomach, and the beginning of the small intestine, a healthcare provider performs an injection into the submucosal layer of the tissue. This procedure is often used to treat conditions such as bleeding or to facilitate the removal of lesions.
For CPT code 43201 (Esophagoscopy with submucosal injection), 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.
2. Modifier 26 - Professional Component: Indicates that the service provided was the professional component only, such as the interpretation of results.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session by the same provider.
4. Modifier 52 - Reduced Services: Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Used when a related procedure during the postoperative period requires a return to the operating room.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary and a qualified resident surgeon is not available.
14. 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 provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43201 is reimbursed by Medicare. This code is included in the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, reimbursement rates may vary depending on the specific Medicare Administrative Contractor (MAC) and geographic location. Healthcare providers should consult their local MAC for precise reimbursement information and any applicable coverage limitations or requirements for this procedure.
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