CPT code 43249 is for esophageal dilation procedures using an endoscope, specifically for dilations less than 30 mm in size.
CPT code 43249 is used to describe a procedure involving the dilation of the esophagus through an endoscopic approach, specifically when the dilation is less than 30 millimeters in diameter. This procedure is typically performed to treat conditions such as esophageal strictures or narrowing, allowing for improved passage of food and liquids.
When billing for CPT code 43249 (Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus <30 mm diameter), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the increased complexity.
2. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service was provided.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Use this modifier if the 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: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician on the same day.
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: Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure was unrelated to the original procedure and performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
14. Modifier GC - This service has been performed in part by a resident under the direction of a teaching physician: Use this modifier if the service was performed by a resident under the supervision of a teaching physician.
15. Modifier QX - CRNA service with medical direction by a physician: Use this modifier if a Certified Registered Nurse Anesthetist (CRNA) provided the service under the medical direction of a physician.
16. Modifier QY - Medical direction of one CRNA by an anesthesiologist: Use this modifier if an anesthesiologist provided medical direction for one CRNA.
17. Modifier QZ - CRNA service without medical direction by a physician: Use this modifier if a CRNA provided the service 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. Always ensure that documentation supports the use of any modifier.
The CPT code 43249 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the local Medicare Administrative Contractor (MAC) for any region-specific policies or coverage determinations that may affect reimbursement for CPT code 43249.
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