CPT code 43273 is a medical billing code used for endoscopic pancreatoscopy procedures, helping providers accurately document and bill for services.
CPT code 43273 is used to describe an endoscopic pancreatoscopy procedure. This involves the use of an endoscope to visualize and access the pancreatic duct, allowing healthcare providers to diagnose and treat conditions related to the pancreas. The procedure may include the removal of stones, biopsies, or other therapeutic interventions within the pancreatic duct system.
For CPT code 43273 (Endoscopic pancreatoscopy), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 26 - Professional Component
- This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for their expertise and interpretation, not the technical component.
3. Modifier 52 - Reduced Services
- Apply this modifier when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should clearly indicate why the service was reduced.
4. Modifier 53 - Discontinued Procedure
- Use this modifier when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. Proper documentation is required to explain the reason for discontinuation.
5. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier when the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by another physician or qualified healthcare professional subsequent to the original procedure.
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
- Use this modifier when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required during the procedure. Documentation should support the necessity of an assistant surgeon.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when an assistant surgeon is required for a minimal portion of the procedure. Documentation should support the necessity of an assistant surgeon for a minimal portion.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available. Documentation should support the necessity of an assistant surgeon.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery. Documentation should support the necessity of their assistance.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is crucial to justify the use of any modifier.
The CPT code 43273, which pertains to endoscopic pancreatoscopy, is reimbursed by Medicare. To determine the reimbursement specifics, 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 is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 43273, and by individual payer. Schedule a demo today to see how RevFind can help you identify and recover lost revenue.
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
