CPT code 43290 is a medical billing code for flexible endoscopic transoral balloon dilation of the esophagus.
CPT code 43290 is for the procedure involving the flexible transoral deployment of a balloon during an esophagogastroduodenoscopy (EGD). This procedure is typically performed to treat conditions such as esophageal strictures or to facilitate the passage of food and liquids through the digestive tract. The use of a balloon helps to dilate the esophagus, improving patient outcomes and alleviating symptoms associated with narrowing of the esophagus.
For CPT code 43290, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 26 (Professional Component): Indicates that only the professional component of the service was provided.
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): Indicates that 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): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 (Repeat Procedure by Same Physician): Indicates that a procedure or service was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 (Repeat Procedure by Another Physician): Indicates that a procedure or service was repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
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): Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Indicates that a minimum assistant surgeon was required during the procedure.
12. 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.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician provider assisted in the surgery.
14. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician): Used when a resident performs part of the service under the supervision of a teaching physician.
15. Modifier QK (Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals): Indicates medical direction of multiple anesthesia procedures.
16. Modifier QS (Monitored Anesthesia Care Service): Used to indicate monitored anesthesia care.
17. Modifier QX (CRNA Service: with Medical Direction by a Physician): Indicates that a Certified Registered Nurse Anesthetist (CRNA) provided the service under the medical direction of a physician.
18. Modifier QY (Medical Direction of One CRNA by an Anesthesiologist): Indicates medical direction of one CRNA by an anesthesiologist.
19. Modifier QZ (CRNA Service: without Medical Direction by a Physician): Indicates that a CRNA provided the service without the medical direction of a physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 43290 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 43290. Additionally, MACs can offer localized insights and any specific requirements or limitations that may apply to the reimbursement of this code in your area.
Always ensure to check both resources to confirm the most accurate and up-to-date information regarding Medicare reimbursement for CPT code 43290.
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 43290, 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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