CPT code 43214 is for the procedure of esophagoscopy with balloon dilation, specifically using a 30 mm balloon.
CPT code 43214 is used to describe a medical procedure involving the dilation of the esophagus using a balloon. This procedure is typically performed to treat conditions that cause narrowing or strictures in the esophagus, allowing for improved passage of food and liquids. The "30" indicates the size of the balloon used during the dilation process.
For CPT code 43214, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure 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 a diagnostic test.
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: Indicates that 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: 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: Used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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: Indicates that a related procedure was 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 or service is performed by the same physician 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 a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Indicates that an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Indicates that a resident performed part of the service under the supervision of a teaching physician.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Used in anesthesia billing to indicate medical direction of multiple procedures.
16. Modifier QS - Monitored Anesthesia Care Service: Indicates that monitored anesthesia care was provided.
17. Modifier QX - CRNA Service: With Medical Direction by a Physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
18. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Indicates that an anesthesiologist provided medical direction for one CRNA.
19. Modifier QZ - CRNA Service: Without Medical Direction by a Physician: Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43214 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 services covered by Medicare, along with their respective reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific billing requirements that may apply to CPT code 43214. The MACs are responsible for processing Medicare claims and can provide detailed guidance on coverage and reimbursement policies for this particular code.
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