CPT code 43252 is a medical billing code for performing optical endomicroscopy during an esophagogastroduodenoscopy (EGD) procedure.
CPT code 43252 is for an esophagogastroduodenoscopy (EGD) procedure that includes the use of optical endomicroscopy. This advanced technique allows healthcare providers to obtain high-resolution images of the gastrointestinal tract, enabling them to assess and diagnose conditions more effectively during the EGD procedure.
For CPT code 43252 (Egd optical endomicroscopy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 26 - Professional Component
- Indicates that only the professional component of the service was provided.
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
- Indicates that a 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
- 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 or Service by Same Physician or Other Qualified Health Care Professional
- 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 or Other Qualified Health Care Professional
- Indicates that 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 or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Used when a patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Indicates that a procedure or service performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during a procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Indicates that a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43252 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services and procedures covered by Medicare, along with their corresponding reimbursement rates.
To ascertain if CPT code 43252 is reimbursed, you would need to verify its inclusion in the MPFS. Additionally, MACs, which are private health care insurers contracted by Medicare to process claims, may have specific local coverage determinations (LCDs) that affect reimbursement. These LCDs can vary by region and may provide additional criteria or restrictions for coverage.
Therefore, to confirm if CPT code 43252 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific local coverage policies.
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