CPT code 43229 is a medical billing code for performing an esophagoscopy to ablate a lesion in the esophagus.
CPT code 43229 is for a procedure involving esophagoscopy, specifically focused on ablating a lesion within the esophagus. This means that during the esophagoscopy, a healthcare provider uses specialized tools to destroy or remove abnormal tissue or growths found in the esophagus, which can help treat conditions such as tumors or precancerous lesions.
For CPT code 43229, which pertains to esophagoscopy with ablation of a lesion, 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: Used when only the professional component of the service is being billed.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services: Used when 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: Used to indicate 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.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Used for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for an unrelated procedure or service by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these professionals assist in surgery.
15. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings.
16. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used in anesthesia billing.
17. Modifier QS - Monitored anesthesia care service: Used to indicate monitored anesthesia care.
18. Modifier QX - CRNA service with medical direction by a physician: Used for anesthesia services provided by a Certified Registered Nurse Anesthetist with physician direction.
19. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Used for anesthesia services.
20. Modifier QZ - CRNA service without medical direction by a physician: Used for anesthesia services provided by a CRNA without physician direction.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43229, which involves esophagoscopy lesion ablation, is reimbursed by Medicare. To determine the reimbursement specifics, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, it is essential to consult with the respective Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage policies, local coverage determinations (LCDs), and any potential variations in reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43229. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
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