CPT code 43279 is a medical billing code for laparoscopic myotomy, specifically the Heller procedure, used to treat esophageal conditions.
CPT code 43279 is for a laparoscopic myotomy procedure known as Heller myotomy. This surgical technique is performed to treat achalasia, a condition that affects the esophagus and makes it difficult for food and liquid to pass into the stomach. During this procedure, the surgeon makes small incisions in the abdomen and uses specialized instruments to cut the muscle fibers at the lower end of the esophagus, allowing for improved passage of food. This minimally invasive approach typically results in less pain and quicker recovery compared to traditional open surgery.
For CPT code 43279 (Lap myotomy heller), 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. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 52 - Reduced Services: Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
4. Modifier 59 - Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. 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 subsequent to the original procedure or service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Applied when a procedure or service is repeated by a different provider subsequent to the original procedure or service.
7. 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: Used when a patient returns to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Indicates that a procedure performed during the postoperative period was unrelated to the original procedure.
9. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Applied when a minimum assistant surgeon is required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
12. 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 43279 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for any local coverage determinations or specific guidelines that may affect reimbursement for CPT code 43279.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 43279. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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