CPT code 43289 is an unlisted laparoscopic procedure for the esophagus, used when no specific code applies for the service provided.
CPT code 43289 is used to describe an unlisted laparoscopic procedure performed on the esophagus. This code is utilized when a specific laparoscopic esophageal procedure does not have a designated code, allowing healthcare providers to report the service while indicating that it falls outside the standard classifications.
For CPT code 43289, which pertains to an unlisted laparoscopic procedure of the esophagus, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 52 - Reduced Services
- This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should clearly indicate the extent of the reduction.
3. Modifier 53 - Discontinued Procedure
- Apply this modifier when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient. Documentation should explain the reason for discontinuation.
4. 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. This is particularly relevant when procedures are not typically reported together but are appropriate under the circumstances.
5. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure. Each surgeon should document their specific role in the procedure.
6. Modifier 66 - Surgical Team
- Apply this modifier when a complex procedure requires the services of several physicians, often of different specialties, working together as a team. Documentation should detail the necessity of a team approach.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
9. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure. Documentation should support the necessity of an assistant surgeon.
12. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required on a minimal basis. Documentation should support the limited involvement of the assistant surgeon.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available. Documentation should support the necessity of the assistant surgeon and the unavailability of a resident.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery. Documentation should support the necessity of their involvement.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is crucial to support the use of any modifier.
CPT code 43289 is not directly reimbursed by Medicare. As an unlisted procedure code, it does not have a set reimbursement rate in the Medicare Physician Fee Schedule (MPFS). When billing this code, providers must submit additional documentation to their Medicare Administrative Contractor (MAC) for individual consideration.
The MAC will review the documentation and determine an appropriate reimbursement amount based on the complexity and resources required for the specific procedure performed.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 43289, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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