CPT code 43238 is a medical billing code for an endoscopic procedure involving fine needle biopsy or aspiration of the esophagus.
CPT code 43238 is for an esophagogastroduodenoscopy (EGD) procedure that involves the use of a fine needle to perform a biopsy or aspiration. This code indicates that the healthcare provider is using an endoscope to visualize the upper gastrointestinal tract, specifically the esophagus, stomach, and duodenum, while simultaneously obtaining tissue samples or aspirating fluid for diagnostic purposes.
For CPT code 43238, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the procedure.
2. 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.
3. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician on the same day.
4. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician on the same day.
5. 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.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
8. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 43238, which involves a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, 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 important to consult with the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MAC is responsible for processing Medicare claims and can provide detailed information on coverage and payment for CPT code 43238.
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 43238. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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