CPT code 43310 is a medical billing code used for the surgical repair of the esophagus, helping healthcare providers document and bill for the procedure.
CPT code 43310 is for the surgical procedure involving the repair of the esophagus. This code is used when a healthcare provider performs a surgical intervention to correct issues such as tears, strictures, or other abnormalities in the esophageal structure. The procedure aims to restore normal function and integrity to the esophagus, ensuring that it can effectively transport food and liquids from the throat to the stomach.
For CPT code 43310 (Repair of esophagus), 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 terminated 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 more than once 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 related procedure is performed during the postoperative period of the initial procedure.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance 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 these non-physician practitioners assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 43310 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.
To verify if CPT code 43310 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect reimbursement. Therefore, it is crucial to review both the MPFS and any relevant LCDs issued by your regional MAC to confirm the reimbursement status of CPT code 43310.
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