CPT code 43270 is a medical billing code for the procedure of ablating lesions during an esophagogastroduodenoscopy (EGD).
CPT code 43270 is for the procedure of endoscopic ablation of a lesion in the esophagus. This code is used when a healthcare provider performs a minimally invasive technique to remove or destroy abnormal tissue in the esophagus using an endoscope. The procedure is typically indicated for patients with esophageal lesions, such as tumors or precancerous growths, and aims to improve patient outcomes by addressing these issues directly.
For CPT code 43270 (Egd lesion ablation), 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 the service provided was the professional component only, such as the interpretation of a diagnostic test.
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 provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
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: Indicates an unplanned return 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: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Indicates that an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43270, which involves EGD lesion ablation, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 43270.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you are fully compensated for procedures like CPT code 43270. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
