CPT code 43275 is for the procedure of removing a foreign body from the bile duct during an endoscopic retrograde cholangiopancreatography (ERCP).
CPT code 43275 is used to describe a procedure in which a foreign body is removed from the bile duct or pancreatic duct during an endoscopic retrograde cholangiopancreatography (ERCP). This procedure typically involves the use of an endoscope to visualize the ducts and instruments to extract the foreign object, which may include stones, stents, or other materials that could obstruct normal duct function.
For CPT code 43275, which pertains to the removal of a foreign body from a duct via ERCP, 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 results.
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 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 that a related procedure was performed during the postoperative period of the initial procedure.
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 involved in 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.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement.
CPT code 43275 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, reimbursement may vary depending on factors such as the specific Medicare Administrative Contractor (MAC) for your region, medical necessity documentation, and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). Providers should consult their local MAC for specific coverage and billing guidelines related to CPT 43275.
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