CPT code 43217 is a medical billing code for an esophagoscopy procedure using a snare to remove lesions from the esophagus.
CPT code 43217 is used to describe a procedure involving an esophagoscopy with the use of a snare to remove lesions from the esophagus. This code indicates that the healthcare provider performed an endoscopic examination of the esophagus and utilized a snare technique to excise abnormal tissue or growths, which may be necessary for diagnostic or therapeutic purposes.
For CPT code 43217, which pertains to esophagoscopy with removal of lesion(s) by snare technique, 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 unusual circumstances.
2. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed, typically applicable in cases where the procedure involves both a technical and professional component.
3. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: This modifier is used if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
8. 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.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
10. 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.
11. Modifier 80 - Assistant Surgeon: This modifier is used if an assistant surgeon was required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
14. 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 accurately to ensure proper billing and reimbursement.
CPT code 43217 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 43217. However, the actual reimbursement can also depend on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. Each MAC may have different local coverage determinations (LCDs) that can affect whether and how much Medicare will reimburse for this specific CPT code. Therefore, it is essential to consult the MPFS and your regional MAC for the most accurate and up-to-date reimbursement information for CPT code 43217.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 43217. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
