CPT code 43314 is a medical billing code for tracheo-esophagoplasty, a surgical procedure to repair the trachea and esophagus.
CPT code 43314 is used to describe a surgical procedure known as tracheo-esophagoplasty, which is performed to reconstruct the trachea and esophagus. This procedure is typically indicated for patients with conditions that affect the integrity or function of these structures, such as congenital anomalies or trauma. The goal of the surgery is to restore normal anatomy and function, allowing for improved breathing and swallowing.
For CPT code 43314 (Tracheo-esophagoplasty, congenital), 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.
2. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
3. Modifier 53 - Discontinued Procedure: Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
4. 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.
5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
6. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when a procedure or service is repeated by the same physician subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician 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: Used when a related procedure is performed during the postoperative period of the initial procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
13. 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.
14. 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 whether CPT code 43314 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 43314 is reimbursed, you would need to check the MPFS database. If the code is listed, it indicates that Medicare provides reimbursement for this service. Additionally, MACs 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 ensure compliance and accurate billing.
In summary, CPT code 43314 may be reimbursed by Medicare if it is included in the MPFS and adheres to any specific guidelines or requirements set by the MAC.
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