CPT code 43246 is a medical billing code for the procedure of placing a gastrostomy tube during an esophagogastroduodenoscopy (EGD).
CPT code 43246 is used to describe the procedure of placing a gastrostomy tube through an endoscopic approach. This involves inserting a tube directly into the stomach via the abdominal wall, allowing for nutritional support in patients who are unable to eat by mouth. The procedure is typically performed using an endoscope, which provides visualization and guidance during the placement of the tube.
For CPT code 43246 (EGD place gastrostomy tube), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure 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 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for 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: Used when these non-physician practitioners assist in surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Used in teaching settings.
15. Modifier QK - Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals: Used when anesthesia services are provided.
16. Modifier QS - Monitored anesthesia care service: Used to indicate monitored anesthesia care.
17. Modifier QX - CRNA service with medical direction by a physician: Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the direction of a physician.
18. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Used when an anesthesiologist directs one CRNA.
19. Modifier QZ - CRNA service without medical direction by a physician: Used when a CRNA provides anesthesia services without the direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43246 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 services covered by Medicare, including the associated payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, healthcare providers should consult the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement for CPT code 43246.
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