CPT code 43280 is a medical billing code for laparoscopic fundoplasty, a minimally invasive surgical procedure to treat gastroesophageal reflux disease.
CPT code 43280 is for a laparoscopic fundoplasty procedure. This minimally invasive surgical technique involves the repair of a hiatal hernia by reinforcing the fundus of the stomach, which is the upper part of the stomach, to the diaphragm. The goal of this procedure is to prevent the stomach from moving up into the chest cavity, thereby alleviating symptoms such as gastroesophageal reflux disease (GERD).
For CPT code 43280, which pertains to laparoscopy fundoplasty, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that necessitate additional time and effort.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. This helps in indicating that the procedure was one of several performed.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This might occur if the full procedure was not necessary or could not be completed.
4. Modifier 53 - Discontinued Procedure: This modifier is used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to avoid bundling issues.
6. Modifier 62 - Two Surgeons: Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician needs to repeat the procedure for the same patient on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician repeats the procedure for the same patient on the same day.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required to help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 43280 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS) and is eligible for payment. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements related to this procedure.
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