CPT code 43206 is a medical billing code for esophageal optical endomicroscopy, a procedure used to examine the esophagus.
CPT code 43206 is a procedure that involves the use of optical endomicroscopy to examine the esophagus. This technique allows healthcare providers to obtain detailed images of the esophageal lining at a microscopic level, aiding in the diagnosis and evaluation of various esophageal conditions. It is typically performed during an endoscopy procedure to enhance visualization and assess abnormalities such as inflammation, lesions, or other pathological changes in the esophagus.
For CPT code 43206 (Esoph optical endomicroscopy), 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 only the professional component of the service was provided.
3. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
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: 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: Used when an unrelated procedure is performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): 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: Indicates that a non-physician provider assisted in the surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used in teaching settings where a resident is involved in the procedure.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Used when a physician is directing multiple anesthesia procedures.
16. Modifier QS - Monitored Anesthesia Care Service: Indicates that monitored anesthesia care was provided.
17. Modifier G8 - Monitored Anesthesia Care (MAC) for Deep Complex, Complicated, or Markedly Invasive Surgical Procedure: Used for specific anesthesia services.
18. Modifier G9 - Monitored Anesthesia Care for Patient Who Has History of Severe Cardiopulmonary Condition: Indicates that the patient has a severe cardiopulmonary condition requiring monitored anesthesia care.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43206, which pertains to esoph optical endomicroscopy, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with the respective Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 43206.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 43206, and by individual payer. Schedule a demo today to see how RevFind can ensure you receive the full reimbursement you deserve.
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