CPT code 43235 is a medical billing code for an esophagogastroduodenoscopy (EGD) diagnostic brush wash procedure.
CPT code 43235 is used to describe a diagnostic procedure involving an esophagogastroduodenoscopy (EGD) with a brush wash. This procedure allows healthcare providers to examine the upper gastrointestinal tract, including the esophagus, stomach, and duodenum, while also collecting samples for further analysis. The brush wash technique specifically involves using a brush to gather cells or tissue from the lining of these organs, which can help in diagnosing various conditions, such as infections or abnormalities.
For CPT code 43235 (EGD diagnostic brush wash), 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: Used when only the professional component of the service is being billed.
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: 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: 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 or service is performed by the same physician during the postoperative period.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
11. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service.
Each of these modifiers serves a specific purpose and should be used according to the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
The CPT code 43235 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 43235. Additionally, MACs may have specific guidelines or requirements that could affect reimbursement.
Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 43235.
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 43235. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
