CPT code 43251 is for the endoscopic removal of a lesion using a snare during an esophagogastroduodenoscopy (EGD) procedure.
CPT code 43251 is used to describe a procedure in which a lesion in the esophagus or stomach is removed using a snare technique during an esophagogastroduodenoscopy (EGD). This minimally invasive approach allows healthcare providers to excise abnormal tissue while minimizing damage to surrounding areas, facilitating both diagnosis and treatment in a single procedure.
When billing for the procedure associated with CPT code 43251, various modifiers may be required to provide additional information about the service rendered. Below is a list of potential modifiers that could be used with CPT code 43251, along with the reasons for their use:
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 51 - Multiple Procedures
- Used when multiple procedures are performed during the same session by the same provider.
4. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. 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.
8. 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.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician
- Used when a related procedure during the postoperative period requires a return to the operating room.
10. 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.
11. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
15. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Used when a resident performs the service under the supervision of a teaching physician.
16. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Used when a physician provides medical direction for multiple anesthesia procedures.
17. Modifier QS - Monitored Anesthesia Care Service
- Used to indicate that monitored anesthesia care was provided.
18. Modifier QX - CRNA Service: With Medical Direction by a Physician
- Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
19. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Used when an anesthesiologist provides medical direction for one CRNA.
20. Modifier QZ - CRNA Service: Without Medical Direction by a Physician
- Used when a CRNA provides anesthesia services without the medical direction of a physician.
These modifiers help to provide a more complete picture of the circumstances surrounding the procedure and ensure accurate billing and reimbursement.
The CPT code 43251, which involves the removal of a lesion using a snare, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it's important to consult with your local Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 43251.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 43251. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve from every payer.
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