CPT code 43250 is a medical billing code for performing cautery on a tumor or polyp during an esophagogastroduodenoscopy (EGD).
CPT code 43250 is used to describe a procedure involving the endoscopic removal of a tumor or polyp from the esophagus or stomach using cautery. This technique involves the application of heat to effectively destroy or cut tissue, allowing for the safe excision of abnormal growths during an esophagogastroduodenoscopy (EGD).
For CPT code 43250 (Egd cautery tumor polyp), 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 size or number of polyps or tumors.
2. Modifier 26 - Professional Component: Use this modifier if only the professional component of the procedure is being billed, typically applicable in scenarios where the technical component is billed separately.
3. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same session. This helps in indicating that the procedure was not the only one performed.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician on the same day.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
13. 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.
14. 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.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43250 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for the provider's region and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). Providers should consult their MAC for specific coverage and payment information related to CPT 43250.
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