CPT code 43233 is a medical billing code for an endoscopic procedure that involves balloon dilation of the esophagus.
CPT code 43233 is used to describe a procedure involving an esophagogastroduodenoscopy (EGD) with balloon dilation of the esophagus. Specifically, this code indicates that a balloon dilation was performed to widen a narrowed section of the esophagus, using a balloon that is 30 mm in diameter. This procedure is typically done to alleviate symptoms caused by strictures or blockages in the esophagus, allowing for improved passage of food and liquids.
For CPT code 43233, 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 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 a 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: Indicates that 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: Used when a related procedure during the postoperative period requires a return to the operating room.
9. 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.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during a procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required during the procedure.
12. 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.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43233 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. Healthcare providers should consult their local MAC for specific coverage guidelines and documentation requirements to ensure proper reimbursement for this procedure.
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