CPT code 43244 is a medical billing code for endoscopic ligation of esophageal varices, a procedure to treat swollen veins in the esophagus.
CPT code 43244 is used to describe the procedure of endoscopic variceal ligation (EVL). This procedure involves the use of an endoscope to identify and treat esophageal varices, which are swollen veins in the esophagus that can bleed. During the procedure, rubber bands are placed around the varices to constrict them, reducing the risk of bleeding. This code is specifically utilized for billing and documentation purposes in healthcare settings when this particular intervention is performed.
For CPT code 43244 (Egd varices ligation), 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: 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: Indicates 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 or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
12. 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.
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.
The CPT code 43244 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare pays for each service, including CPT code 43244. Additionally, reimbursement can vary based on the region and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that area. Each MAC may have different guidelines and rates, so it is crucial to consult the relevant MAC for precise information on the reimbursement for CPT code 43244.
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