CPT code 43288 is a medical billing code used to describe esophageal therapeutic procedures involving thoracic mobilization.
CPT code 43288 is used to describe an esophagogastroduodenoscopy (EGD) procedure with therapeutic interventions, specifically involving the use of a balloon dilation technique. This procedure is typically performed to treat strictures or obstructions in the esophagus, allowing for improved passage of food and liquids. It involves the insertion of an endoscope through the mouth to visualize the esophagus, stomach, and duodenum, while also enabling the physician to perform necessary therapeutic actions to alleviate the patient's condition.
For CPT code 43288, 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 increased the complexity of the procedure.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same session. This helps in indicating that more than one procedure was carried out.
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: This modifier is used if the procedure was started but had to be discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Apply this modifier when a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the same procedure was repeated by a different physician on the same day.
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: Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. 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 of the initial procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon was required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
Determining if CPT code 43288 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their corresponding reimbursement rates.
To verify if CPT code 43288 is reimbursed, you should:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database and search for CPT code 43288. This will indicate whether the code is listed and if it has an associated reimbursement rate.
2. Consult Your MAC: Each MAC may have specific guidelines and coverage determinations that can affect reimbursement. It's essential to review any Local Coverage Determinations (LCDs) or National Coverage Determinations (NCDs) related to CPT code 43288.
By following these steps, you can ascertain whether CPT code 43288 is reimbursed by Medicare.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 43288. Identify discrepancies by individual payer and take control of your revenue cycle. Schedule a demo today to see how RevFind can optimize your financial outcomes.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
