CPT code 43274 is for the placement of a stent in the duct during an endoscopic retrograde cholangiopancreatography (ERCP) procedure.
CPT code 43274 is for the placement of a stent in the duct during an endoscopic retrograde cholangiopancreatography (ERCP) procedure. This code specifically indicates that a healthcare provider has performed a procedure to insert a stent to help maintain the patency of the duct, which can be necessary for managing conditions affecting the bile or pancreatic ducts.
For CPT code 43274 (ERCP duct stent placement), 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 the procedure.
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 the 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 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.
7. 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.
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: 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 During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
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 provides minimal assistance during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Indicates that an assistant surgeon was necessary because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
14. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Indicates that a resident performed part of the service under the supervision of a teaching physician.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Used in anesthesia billing when the anesthesiologist is directing multiple procedures.
16. Modifier QS - Monitored Anesthesia Care Service: Indicates that monitored anesthesia care was provided.
17. 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.
18. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Indicates that an anesthesiologist is directing one CRNA.
19. 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 provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When considering the reimbursement of CPT code 43274 by Medicare, it is essential to refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
CPT code 43274, which involves a specific medical procedure, is indeed reimbursed by Medicare. However, the exact reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that region. Each MAC may have slightly different policies and fee schedules, so it is crucial for healthcare providers to consult their local MAC for precise reimbursement details.
In summary, CPT code 43274 is reimbursed by Medicare, but providers should verify the specific reimbursement rates and policies with their respective MAC and the MPFS.
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