CPT code 43312 is used for the surgical repair of the esophagus and any associated fistula, detailing the specific procedure performed.
CPT code 43312 is used to describe the surgical procedure for repairing the esophagus and any associated fistula. This code indicates that a healthcare provider has performed a surgical intervention to correct abnormalities in the esophagus, which may involve closing an abnormal connection (fistula) between the esophagus and another structure. This procedure is typically necessary to restore normal function and prevent complications related to esophageal disorders.
For CPT code 43312 (Repair esophagus and fistula), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
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 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. This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
7. Modifier 66 - Surgical Team: Used when a team of surgeons (more than two) is required to perform a specific procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated subsequent to the original procedure or service.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used to indicate that a procedure or service was repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional 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 or Other Qualified Health Care Professional During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required 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.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 43312 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, reimbursement may vary depending on factors such as geographic location and the specific Medicare Administrative Contractor (MAC) processing the claim. Providers should consult their local MAC for specific coverage and payment guidelines related to CPT 43312.
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