CPT code 43247 is a medical billing code used for the procedure of removing a foreign body from the esophagus during an endoscopy.
CPT code 43247 is used to describe a procedure in which a healthcare provider performs an esophagogastroduodenoscopy (EGD) to remove a foreign body from the upper gastrointestinal tract. This procedure involves the insertion of a flexible tube with a camera and tools through the mouth, allowing the provider to visualize and extract the foreign object safely.
For CPT code 43247 (EGD remove foreign body), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity or difficulty of removing the foreign body.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same session. This indicates that 43247 was one of several procedures.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same procedure was repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure was repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.
9. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is 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 reimbursement of CPT code 43247 by Medicare is determined by the Medicare Physician Fee Schedule (MPFS) and the policies set forth by the Medicare Administrative Contractor (MAC) for your specific region.
To ascertain if CPT code 43247 is reimbursed, you should consult the MPFS, which provides a comprehensive list of services covered by Medicare along with their respective reimbursement rates.
Additionally, it is crucial to review the local coverage determinations (LCDs) and national coverage determinations (NCDs) issued by your MAC, as these documents outline the specific conditions under which Medicare will reimburse for this procedure.
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 43247. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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