CPT code 43236 is for an upper gastrointestinal scope procedure with submucosal injection, used to diagnose and treat conditions in the upper GI tract.
CPT code 43236 is used to describe an upper gastrointestinal (GI) endoscopy procedure that includes the injection of a substance into the submucosal layer of the gastrointestinal tract. This procedure is typically performed to treat conditions such as bleeding or to facilitate the removal of lesions. The code indicates that the endoscopy is not just a diagnostic procedure but also involves therapeutic intervention through the injection.
For CPT code 43236, which pertains to an upper gastrointestinal endoscopy with submucosal injection, 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 only the professional component of the service was provided.
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 or Service 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 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: 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 the 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 physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used when a resident performs 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: Indicates medical direction of multiple concurrent anesthesia procedures.
16. Modifier QS - Monitored Anesthesia Care Service: Used to indicate that monitored anesthesia care was provided.
17. Modifier QX - CRNA Service: With Medical Direction by a Physician: Indicates that a Certified Registered Nurse Anesthetist (CRNA) provided 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: Indicates that a CRNA provided 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.
CPT code 43236 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for your region, medical necessity documentation, and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). Providers should consult their local MAC for specific coverage and billing guidelines related to CPT 43236.
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