CPT code 43287 is a medical billing code for esophageal dilation using a laparoscopic approach.
CPT code 43287 is used to describe a procedure involving the distal esophagus, specifically a laparoscopic mobilization of the distal two-thirds of the esophagus. This procedure typically involves surgical techniques to access and manipulate the esophagus, often performed to treat conditions such as gastroesophageal reflux disease (GERD) or esophageal cancer. The laparoscopic approach indicates that the surgery is done using small incisions and specialized instruments, which generally leads to quicker recovery times and less postoperative pain compared to traditional open surgery.
When using CPT code 43287, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session.
3. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: Apply this modifier if 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: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: Apply this modifier if two surgeons were required to perform the procedure together.
7. Modifier 66 - Surgical Team: Use this modifier if the procedure required a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same physician performed the procedure again on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician performed the procedure again 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: Apply this modifier if the patient had 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: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Apply this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
Determining if CPT code 43287 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 and their corresponding reimbursement rates, while the MACs administer Medicare claims and provide local coverage determinations.
To verify if CPT code 43287 is reimbursed, you would first check the MPFS to see if the code is listed and if it has an assigned reimbursement rate. If the code is present in the MPFS, it indicates that Medicare recognizes and reimburses the service. Additionally, it's essential to review any local coverage determinations (LCDs) or national coverage determinations (NCDs) provided by your MAC, as these documents can offer specific guidelines or restrictions related to the reimbursement of CPT code 43287.
In summary, CPT code 43287 is reimbursed by Medicare if it is listed in the MPFS with an assigned reimbursement rate and adheres to any relevant guidelines or restrictions set by the MAC.
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