CPT code 43281 is a medical billing code used for laparoscopic repair of a paraesophageal hernia.
CPT code 43281 is for a laparoscopic paraesophageal hernia repair. This procedure involves using minimally invasive techniques to correct a paraesophageal hernia, which occurs when part of the stomach pushes through the diaphragm and into the chest cavity. The laparoscopic approach allows for smaller incisions, reduced recovery time, and less postoperative pain compared to traditional open surgery.
For CPT code 43281 (Lap paraesophag hern repair), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
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: Used when a procedure is 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 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
7. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.
8. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service again on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician 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: Used when a patient requires a 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: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
14. 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.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when a non-physician provider assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
Determining if CPT code 43281 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Additionally, MACs, which are private health care insurers contracted by Medicare, have the authority to make local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed.
To verify if CPT code 43281 is reimbursed, you would need to:
1. Check the MPFS: Access the MPFS database to see if CPT code 43281 is listed and review the associated reimbursement rate.
2. Consult Your MAC: Since MACs can have specific guidelines and policies, it is crucial to check with the MAC that administers Medicare claims in your region. They may have additional criteria or documentation requirements that impact reimbursement.
By following these steps, you can determine if CPT code 43281 is eligible for reimbursement under Medicare.
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