CPT code 43326 is a medical billing code used to describe the procedure of revising the esophagus and stomach.
CPT code 43326 is used to describe a surgical procedure that involves revising or correcting the esophagus and stomach. This may include adjustments to the anatomical structure or function of these organs, often performed to address complications or issues arising from previous surgeries or conditions affecting the esophagus and stomach.
When using CPT code 43326 for revising the esophagus and stomach, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or the patient's condition.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was carried out.
3. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. It indicates that the full service described by the CPT code was not performed.
4. Modifier 53 - Discontinued Procedure
- Use this modifier if 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
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their distinct operative work.
7. Modifier 66 - Surgical Team
- Use this modifier when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician repeats the procedure 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
- This modifier is used when the patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when a procedure performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when an assistant surgeon is required for a minimal portion of the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier when a non-physician provider assists in the surgery.
Each modifier provides specific information that can affect billing and reimbursement, so it is crucial to use them accurately to ensure proper coding and payment.
Determining whether CPT code 43326 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 and their corresponding reimbursement rates under Medicare Part B.
To verify if CPT code 43326 is reimbursed, you would need to check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries, may have specific local coverage determinations (LCDs) that affect reimbursement.
In summary, to determine if CPT code 43326 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific guidelines or coverage determinations.
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 43326. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
