CPT code 43267 is a medical billing code used for endoscopic cholangiopancreatography procedures to document and bill for services rendered.
CPT code 43267 is used to describe an endoscopic procedure known as endoscopic cholangiopancreatography. This procedure involves the use of an endoscope to visualize and assess the bile ducts and pancreatic duct. It is typically performed to diagnose and treat conditions such as obstructions, stones, or tumors in these ducts. The code specifically indicates that the procedure includes the injection of contrast material to enhance imaging during the examination.
Modifiers for CPT Code 43267 (Endo cholangiopancreatograph):
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 the service provided was the professional component only, such as the interpretation of the procedure.
3. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Indicates 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: Used when the same physician performs a procedure or service more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Indicates that a procedure or service was repeated by another 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: 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 During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the 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 necessary, and 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 non-physician provider assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
Determining if CPT code 43267 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 their corresponding reimbursement rates under Medicare Part B.
To verify if CPT code 43267 is reimbursed, you would need to check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website or other authorized platforms that provide access to the MPFS. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, can offer specific guidance on whether this code is covered and any particular conditions or documentation requirements that must be met for reimbursement.
In summary, CPT code 43267 may be reimbursed by Medicare, but it is essential to consult the MPFS and your regional MAC for definitive information and any specific billing requirements.
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